Abstract
Purpose of ReviewIn this review, we highlight which livers may benefit from additional treatment before implantation and describe the concept of hypothermic machine liver perfusion. Furthermore, we explain why cold oxygenated perfusion concepts could potentially lead to a breakthrough in this challenging field of transplantation. Accordingly, we summarize recent clinical applications of different hypothermic perfusion approaches.Recent FindingsThe impact of end-ischemic, hypothermic liver perfusion in liver transplantation is currently assessed by two multicenter, randomized controlled trials. Recently, new applications of hypothermic perfusion showed promising results and recipients were protected from severe intrahepatic biliary complications, despite the use of very extended criteria grafts including donation after circulatory death livers.SummaryHypothermic machine liver perfusion is beneficial for high-risk livers and protects recipients from most feared complications. Importantly, such easy approach is currently implemented in several European centers and new markers obtained from perfusate may improve the prediction of liver function in the future.
Highlights
This article is part of the Topical Collection on Machine Preservation of the LiverThe worldwide need of organs for transplantation has triggered a revival of machine perfusion techniques, with the aim to rescue organs previously not considered for transplantation
Based on the excellent results in conventionally stored non-injured liver grafts [1], the aim for machine perfusion in the field appears ambitious; machine perfusion should offer a real repair of high-risk organs before implantation, should allow testing of organ function, and potentially enable prolonged preservation, if needed for logistic reasons [2]
The majority of experimental studies published on hypothermic machine perfusion (HMP) in the last 20 years involved mainly ex vivo liver perfusions without implantation [54]
Summary
The worldwide need of organs for transplantation has triggered a revival of machine perfusion techniques, with the aim to rescue organs previously not considered for transplantation. Machine perfusion procedures need to be most practical and affordable. To meet such challenges, an extensive understanding of the underlying. This review focuses on recent developments and research in cold perfusion techniques in liver transplantation. We highlight pros and cons of cold liver perfusion. We report on new findings regarding mechanism of injury and protection during and after cold liver perfusion. We provide a clinical outlook and report on current human applications
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