Role of Machine Perfusion in Liver Transplantation

Alban Longchamp, Tsukasa Nakamura, Korkut Uygun, James F. Markmann

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Liver transplantation stands as the sole curative treatment for individuals suffering from end-stage liver disease. Although tremendous progress has been made over the past years in the fields of procurement, preservation, surgical techniques, and post-transplant immunosuppression, the mortality on the waiting list remains high due to an ever-increasing shortage of suitable donor organs.1 This current shortage of organs led to an increase in the utilization of extended criteria donors (ECDs) for transplantation, which has the potential to address the unmet needs in liver transplantation. Unfortunately, ECD livers have a higher likelihood of developing early allograft dysfunction (EAD), primary nonfunction (PNF), or serious late-onset complications such as ischemic cholangiopathy (IC).2 In the recent years, ex vivo liver machine perfusion before transplantation has emerged as an attractive approach. Using machine perfusion, the rate of complications observed with donation after circulatory death (DCD) livers was found to be comparable to that of livers obtained following brainstem death (donation after brain death [DBD]).3,4 In addition to graft preservation, machine perfusion offers an opportunity to assess the organ viability, increase organ sharing, and treat or repair livers historically considered unsuitable for transplantation. Moreover, studies have also reported positive impact of machine perfusion on graft rejection5 and the recurrence of hepatocellular carcinoma.6 The latter highlights potential broader therapeutic effects machine perfusion. Although machine perfusion has not yet surpassed the advantages of the simple and inexpensive static cold storage (SCS) (in particular for standard or DBD organs), the rapid increase in the utilization of ECD livers for transplantation has led to a significant interest in the use and development of machine perfusion technologies. These advancements are expected to revolutionize the field in the near future. In this review, the authors discuss the role of machine perfusion in liver transplantation with a particular focus on its clinical application.
Original languageEnglish (US)
Pages (from-to)45-65
Number of pages21
JournalSurgical Clinics of North America
Volume104
Issue number1
DOIs
StatePublished - Feb 2024

Keywords

  • Liver
  • Liver transplantation
  • Machine perfusion
  • Post-transplant
  • Surgical techniques

PubMed: MeSH publication types

  • Journal Article
  • Review

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