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Machine Perfusion and Innovations in Liver Transplant Preservation

  • Solid Organ Transplantation (C. Sonnenday, Section Editor)
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Abstract

The use of ex vivo machine preservation/perfusion (MP) remains investigational in clinical liver transplantation. MP is a platform that provides continuous circulation of nutrients and metabolic substrates and oxygen during the ex vivo period. Over the last few years, several groups worldwide have been actively translating MP into the clinical arena for liver transplantation. Groups are investigating ex vivo MP at various temperatures and with various perfusates and devices. There have been several promising preliminary clinical series of liver hypothermic MP (HMP) published over the last 5 years. Normothermic MP (NMP) is currently undergoing clinical investigation in Europe with promising clinical reports. There has been excellent clinical experience with HMP in small series including those recovered from extended criteria donors and donation after cardiac death donors. While some variability exists in technique, all clinical HMP series to date have reported improved outcomes with reductions in early allograft dysfunction, biliary complications, and reduced hospital length of stay. These benefits, together with the development of innovative portable MP devices and further adoption by more centers worldwide, have “broken the ice” for more widespread use of HMP and subsequent expanded elucidation of the benefits of MP in liver transplantation. Optimal temperatures and protocols are still a topic of debate.

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Abbreviations

DCD:

Donation after cardiac death

ECD:

Extended criteria donor

ECMO:

Extracorporeal membrane oxygenation

HMP:

Hypothermic machine perfusion

IRI:

Ischemia/reperfusion injury

LOS:

Length of stay

MP:

Machine perfusion

NMP:

Normothermic machine perfusion

ROS:

Reactive oxygen species

SCS:

Static cold storage

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY, USA

    Tarunjeet S. Klair & James V. Guarrera

  2. Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th Street PH 14 Center, New York, NY, 10032, USA

    James V. Guarrera

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  1. Tarunjeet S. Klair
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  2. James V. Guarrera
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Correspondence to James V. Guarrera.

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This article is part of the Topical Collection on Solid Organ Transplantation.

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Klair, T.S., Guarrera, J.V. Machine Perfusion and Innovations in Liver Transplant Preservation. Curr Surg Rep 4, 2 (2016). https://doi.org/10.1007/s40137-015-0125-y

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