Advancements in ex vivo machine perfusion for abdominal organ transplantation

Organ transplantation remains the definitive treatment for end-stage organ failure, yet its impact continues to be constrained by a persistent shortage of suitable donor organs. Despite advances in surgical technique, immunosuppression, and recipient management, organ preservation has remained relatively unchanged for decades. Machine perfusion (MP) has emerged as a transformative advancement in organ preservation, shifting the paradigm from passive storage to active organ support. By actively circulating perfusate under controlled conditions, MP enables metabolic support, mitigation of ischemic injury, and functional assessment prior to implantation. These modalities collectively represent a paradigm shift from passive preservation toward active resuscitation and repair. This review synthesizes current advances in MP across abdominal organ transplantation, emphasizing the scientific rationale, technical evolution, organ-specific applications, and translational challenges. By examining key clinical trials, emerging biomarkers, and future directions we aim to delineate the roadmap for integrating MP into routine clinical practice and realize its full potential in expanding the donor pool and improving graft outcomes.