Kim SH. Machine perfusion in liver transplantation: A step forward, but still on the runway. World J Gastroenterol 2025; 31(40): 112408 [DOI: 10.3748/wjg.v31.i40.112408]
Corresponding Author of This Article
Seoung Hoon Kim, MD, PhD, Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Gyeonggi-do, South Korea. kshlj@hanmail.net
Research Domain of This Article
Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 28, 2025 (publication date) through Oct 30, 2025
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Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Kim SH. Machine perfusion in liver transplantation: A step forward, but still on the runway. World J Gastroenterol 2025; 31(40): 112408 [DOI: 10.3748/wjg.v31.i40.112408]
World J Gastroenterol. Oct 28, 2025; 31(40): 112408 Published online Oct 28, 2025. doi: 10.3748/wjg.v31.i40.112408
Machine perfusion in liver transplantation: A step forward, but still on the runway
Seoung Hoon Kim
Seoung Hoon Kim, Organ Transplantation Center, National Cancer Center, Goyang 10408, Gyeonggi-do, South Korea
Author contributions: Kim SH contributed to conceived and designed the study, collected and analyzed the data, performed the analysis and wrote the paper.
Conflict-of-interest statement: The author declares that he has no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seoung Hoon Kim, MD, PhD, Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Gyeonggi-do, South Korea. kshlj@hanmail.net
Received: July 25, 2025 Revised: August 14, 2025 Accepted: September 11, 2025 Published online: October 28, 2025 Processing time: 93 Days and 18.1 Hours
Abstract
The recent editorial by Parente et al provides a balanced overview of machine perfusion (MP) in liver transplantation. While its potential to improve graft preservation is clear, several challenges hinder routine adoption: High costs, logistical complexity, lack of standardized viability criteria, limited long-term outcome data, and absence of direct comparisons between hypothermic and normothermic MP. From my experience of over 900 liver transplants without MP, and the limited uptake among Korean centers, compelling evidence for its necessity remains lacking. The immunomodulatory effects of MP, particularly in ABO-incompatible or sensitized recipients, remain underexplored. Future research should integrate immune profiling, mechanistic analyses, and biomarker-guided immunosuppression strategies into multicenter trials to clarify its role in tolerance induction and long-term graft protection. Ethical, regulatory, and policy considerations especially in resource-limited settings must also be addressed to ensure equitable access. Robust clinical and mechanistic data are essential before MP can be fully endorsed as standard care.
Core Tip: Machine perfusion (MP) may enhance graft preservation and modulate immune responses, but high costs, logistical barriers, and lack of standardized viability criteria limit its routine use. Long-term outcome data and head-to-head comparisons between perfusion strategies remain scarce, and uptake is low in Korean liver transplant centers. Robust multicenter trials integrating immune profiling and biomarker-guided immunosuppression are needed before MP can be endorsed as standard practice.
