Machine perfusion of the liver: Putting the puzzle pieces together

Abstract

The realm of extended criteria liver transplantation created the 'adjacent possible' for dynamic organ preservation. Machine perfusion of the liver greatly expanded donor organ preservation possibilities, reaching before unattainable goals, including the mitigation of ischemia-reperfusion injury, viability assessment, and organ reconditioning prior to transplantation. However, current scientific evidence lacks uniformity between studies, perfusion protocols, and acceptance criteria. Construction of collaborative research networks for sharing knowledge should, therefore, enable the development of high-level evidence and guidelines for machine perfusion utilization, including donor acceptance criteria. Finally, this approach shall guarantee conditions for further progress to occur.

Keywords: Machine perfusion of the liver; Liver transplantation; Organ donation; Extended criteria donors; Liver preservation; Clinical trials

Core Tip: The frequent use of extended criteria donor organs unveiled the limits of static cold storage and created the conditions for the renewed interest in dynamic organ preservation. Indeed, several studies have suggested the superiority of this method over static cold storage for these high-risk donors. However, controversy still exists between different machine perfusion modalities and even amongst studies employing the same method, compromising the strength of the available evidence. With the currently fragmented efforts, the development of collaborative networks will produce collective outcomes that will expand the boundaries of current knowledge.