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Current review of machine perfusion in liver transplantation from the Japanese perspective

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Abstract

In light of the present evidence, machine perfusion is opening up new horizons in the field of liver transplantation. Although many advances have been made in liver transplantation, organ preservation methods have so far changed very little. Static cold storage is universally used for graft preservation in liver transplantation; however, there is a need for better preservation methods, such as ex vivo machine perfusion, to improve the outcomes by decreasing warm ischemic damage. Based on the findings of basic and clinical trials, hypothermic and normothermic machine perfusion techniques are now commercially available and include the OrganOx metra, Liver Assist, Cleveland NMP device, Organ Care System, and LifePort Liver. Recent clinical trials have provided further evidence for the potential role of normothermic machine perfusion to resuscitate and subsequently improve utilization of marginal or currently discarded livers. Further studies are required to explore the longer‐term outcomes, late biliary complications, outcomes in specific high‐risk groups, viability biomarkers, optimum and maximum perfusion duration, perfusate composition, and liver‐directed therapeutic interventions during normothermic machine perfusion. The use of organs from marginal donors after brain death, such as fatty livers and the livers from elderly donors with multiple comorbidities, may be accepted for machine perfusion in Japan in the near future.

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Abbreviations

DCD:

Donation after cardiac death

DBD:

Donation after brain death

MP:

Machine perfusion

SCS:

Static cold storage

HMP:

Hypothermic machine perfusion

NMP:

Normothermic machine perfusion

SNMP:

Subnormothermic machine perfusion

HOPE:

Hypothermic oxygenated machine perfusion

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

IRI:

Ischemia/reperfusion injury

ATP:

Adenosine triphosphate

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of this manuscript.

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  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Noboru Harada, Tomoharu Yoshizumi & Masaki Mori

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Harada, N., Yoshizumi, T. & Mori, M. Current review of machine perfusion in liver transplantation from the Japanese perspective. Surg Today 52, 359–368 (2022). https://doi.org/10.1007/s00595-021-02265-x

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