Abstract
The increasing disparity between the number of patients listed for transplantation and the number of suitable organs has led to the increasing use of extended criteria donors (ECDs). ECDs are at increased risk of developing ischaemia reperfusion injury and greater risk of post-transplant complications. Ischaemia reperfusion injury is a major complication of organ transplantation defined as the inflammatory changes seen following the disruption and restoration of blood flow to an organ—it is a multifactorial process with the potential to cause both local and systemic organ failure. The utilisation of machine perfusion under normothermic (37 degrees Celsius) and hypothermic (4–10 degrees Celsius) has proven to be a significant advancement in organ preservation and restoration. One of the key benefits is its ability to optimise suboptimal organs for successful transplantation. This review is focused on examining ischaemia reperfusion injury and how machine perfusion ameliorates the graft’s response to this.
Highlights
Liver transplantation remains the only definitive curative intervention for individuals with end-stage liver disease [1]
The advancements in machine perfusion for liver transplantation have allowed for the successful utilisation of extended criteria donors providing a future avenue to combat the increasing length of transplant waiting lists
Elucidating the individual mechanisms behind each type of machine perfusion is a crucial step in advancing machine perfusion technology and we are confident that great strides will take place in the near future
Summary
Liver transplantation remains the only definitive curative intervention for individuals with end-stage liver disease [1]. The gold standard of organ preservation at present remains static cold storage (SCS), a process which relies on the storage and transportation of the organ on ice, infused with specialist fluid, to reduce cellular metabolism and injury This technique has been used for decades and works well in good quality donors. Machine perfusion is a novel method of organ preservation that facilitates the preservation and optimisation of organs under variable temperatures This technique has seen great success in kidney transplantation, where it was initially developed, and over the past decade has become increasingly prevalent in the optimisation of liver grafts prior to transplantation with significant clinical success [6,7]. This review will discuss the pathophysiology of ischemic reperfusion injury and how machine perfusion ameliorates this injury
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