Normothermic and subnormothermic ex-vivo liver perfusion in liver transplantation.

Abstract

In the current era of extreme organ shortage, warm (subnormothermic and normothermic) ex-vivo liver perfusion has emerged as a novel strategy to recover marginal organs and increase the organ pool. Over the last decade, significant progress in the field has taken this technology from bench to bedside. This review will cover the most relevant contributions to the field in 2015. Several groups made significant advances in warm ex-vivo liver perfusion for optimizing preservation of liver grafts. With transition to clinical use underway, significant interest has focused on exploring the safety and feasibility of the technique. Other areas of exploration included novel perfusates and rewarming strategies. This review will also summarize the most recent advances in the clinical setting. Warm ex-vivo liver perfusion has established itself as a novel approach for the preservation of liver grafts for transplantation. Although the optimal perfusion conditions and techniques have not been established, the safety of this technique has been demonstrated in preclinical and clinical studies. Thus far, most investigation has focused on the rescue of marginal grafts. However, further development in the field has the potential to yield novel graft interventions and modification.