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Updated: Aug 14, 2026
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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Machine Perfusion in Liver Transplantation: A Systematic Review and Meta-Analysis Comparing Outcomes with
Jamilya Saparbay1,2, Timur Lesbekov3, Yuliya Semenova1
1Department of Surgery, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khans Street, Astana 010000, Kazakhstan.
Journal of Clinical Medicine
|August 13, 2026
Summary
Machine perfusion (MP) significantly improves liver transplant outcomes compared to static cold storage (SCS), reducing early allograft dysfunction and primary non-function. Hypothermic perfusion strategies were key drivers of these benefits, enhancing graft survival.
Area of Science:
- Transplantation immunology
- Organ preservation techniques
- Surgical outcomes research
Background:
- Static cold storage (SCS) is the standard for liver preservation but can lead to ischemia-reperfusion injury, especially with marginal donor livers.
- Machine perfusion (MP) offers a promising alternative, but comprehensive comparisons across modalities are lacking.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing all MP strategies against SCS for adult liver transplantation.
- To perform subgroup analyses based on perfusion modality (normothermic vs. hypothermic).
Main Methods:
- Systematic literature search of MEDLINE, Embase, and PubMed (2015-2025) following PRISMA 2020 guidelines.
- Meta-analysis of 21 studies (3665 patients) assessing early allograft dysfunction (EAD), primary non-function (PNF), and 1-year graft survival.
- Modality-specific subgroup analyses comparing normothermic (NMP) and hypothermic (HMP/HOPE) perfusion.
Main Results:
- MP significantly reduced the risk of EAD (RR 0.67), PNF (RR 0.31), and 1-year graft loss (RR 0.54) compared to SCS.
- Hypothermic MP/HOPE strategies drove the reductions in EAD and PNF; NMP did not reach statistical significance for these outcomes.
- No significant differences were found in biliary complications or hepatic artery thrombosis between MP and SCS.
Conclusions:
- Machine perfusion improves early graft function, reduces primary non-function, and enhances 1-year graft survival in liver transplantation versus SCS.
- The benefits of MP for early graft outcomes are primarily attributed to hypothermic preservation strategies.
- Findings support modality-specific evidence for selecting optimal liver graft preservation methods in clinical practice.
