Abstract
Liver ischaemia–reperfusion injury (IRI) is an intrinsic part of the transplantation process and damages the parenchymal cells of the liver including hepatocytes, endothelial cells and cholangiocytes. Many biomarkers of IRI have been described over the past two decades that have attempted to quantify the extent of IRI involving different hepatic cellular compartments, with the aim to allow clinicians to predict the suitability of donor livers for transplantation. The advent of machine perfusion has added an additional layer of complexity to this field and has forced researchers to re-evaluate the utility of IRI biomarkers in different machine preservation techniques. In this review, we summarise the current understanding of liver IRI biomarkers and discuss them in the context of machine perfusion.
Highlights
Liver transplantation (LT) remains the only curative treatment for patients with end-stage liver disease or fulminant hepatic failure
In the prospective randomised European normothermic MP (NMP) trial, comparing perfusion with static cold storage (SCS), the perfused arm showed significant improvement in liver utilisation [20]. This was an unexpected finding, as all enrolled livers were from donors that were considered transplantable upon entry into the study, and might have occurred due to the mitigation of ischaemia–reperfusion injury (IRI) that lessened the peri-transplant instability in marginal graft recipients [21]
Transplanting donor livers with severe macrosteatosis is associated with an increased risk of primary non-function (PNF), and in experimental animal models of IRI, hepatic levels of IL-33 decreased while Cyclin D1 levels increased
Summary
Liver transplantation (LT) remains the only curative treatment for patients with end-stage liver disease or fulminant hepatic failure. There is a worldwide discrepancy between the number of eligible patients in need of LT and the number of available donor livers This shortage causes ongoing waiting list mortality [1] and the transplant community has endeavoured to utilise a wider pool of potential donor organs in order to bridge this deficit [2]. This has entailed the utilisation of extended criteria grafts, such as steatotic livers and organs donated after circulatory death (DCD). We summarise the current understanding of the IRI mechanism and discuss its biomarkers in the context of machine perfusion
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
