Bickaite-Bausiene K, Kvietkauskas M, Leber B, Bausys B, Brislinger D, Strupas K, Stiegler P. Small animal ex vivo machine perfusion of the liver: A comprehensive literature review. World J Gastroenterol 2026; 32(9): 111199 [DOI: 10.3748/wjg.v32.i9.111199]
Corresponding Author of This Article
Klaudija Bickaite-Bausiene, MD, Doctor, Division of General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz 8036, Steiermark, Austria. klaudija.bickaite@santa.lt
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Gastroenterology & Hepatology
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Systematic Reviews
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Mar 7, 2026 (publication date) through Mar 2, 2026
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World Journal of Gastroenterology
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1007-9327
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Bickaite-Bausiene K, Kvietkauskas M, Leber B, Bausys B, Brislinger D, Strupas K, Stiegler P. Small animal ex vivo machine perfusion of the liver: A comprehensive literature review. World J Gastroenterol 2026; 32(9): 111199 [DOI: 10.3748/wjg.v32.i9.111199]
World J Gastroenterol. Mar 7, 2026; 32(9): 111199 Published online Mar 7, 2026. doi: 10.3748/wjg.v32.i9.111199
Small animal ex vivo machine perfusion of the liver: A comprehensive literature review
Klaudija Bickaite-Bausiene, Mindaugas Kvietkauskas, Bettina Leber, Bernardas Bausys, Dagmar Brislinger, Kestutis Strupas, Philipp Stiegler
Klaudija Bickaite-Bausiene, Bettina Leber, Philipp Stiegler, Division of General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz 8036, Steiermark, Austria
Klaudija Bickaite-Bausiene, Mindaugas Kvietkauskas, Kestutis Strupas, Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Mindaugas Kvietkauskas, Experimental Surgery and Oncology Laboratory, Translational Health Research Institute, Faculty of Medicine, Vilnius University, Vilnius 08406, Lithuania
Bernardas Bausys, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Dagmar Brislinger, Department of Cell Biology, Histology and Embryology, Medical University of Graz, Graz 8010, Steiermark, Austria
Author contributions: Bickaite-Bausiene K conducted the research and wrote the main manuscript text; Kvietkauskas M and Bausys B provided significant support in data analysis, interpretation, and manuscript preparation; Leber B and Brislinger D contributed to the critical review and editing of the manuscript; Strupas K and Stiegler P supervised the project, contributed to the conceptual design, and provided critical revisions; all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Klaudija Bickaite-Bausiene, MD, Doctor, Division of General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz 8036, Steiermark, Austria. klaudija.bickaite@santa.lt
Received: June 25, 2025 Revised: September 29, 2025 Accepted: January 19, 2026 Published online: March 7, 2026 Processing time: 247 Days and 17.2 Hours
Abstract
BACKGROUND
Liver transplantation is the only treatment for acute and chronic liver failure, but the global organ shortage has increased reliance on extended criteria donor livers, which are more susceptible to ischemia-reperfusion injury. While static cold storage is standard, these grafts often require improved preservation strategies.
AIM
To summarize the current state of small animal liver machine perfusion (MP), highlight variability in protocols, and emphasize the need for standardization to guide future research.
METHODS
A comprehensive literature search of PubMed was conducted to identify studies on small animal (rat and mouse) ex vivo liver MP. Only English-language animal studies were included, with no restrictions on publication date. Relevant full-text articles were reviewed, and reference lists were screened to ensure completeness.
RESULTS
Small animal liver MP provides a cost-effective model to explore dynamic preservation strategies. Rat perfusion studies face challenges including dual-vessel perfusion, maintaining physiological perfusate volumes, and lack of standardized protocols. Open- and closed-circuit setups have distinct advantages and limitations, and experimental designs vary widely across studies.
CONCLUSION
This review illustrates the wide variability in small animal liver MP protocols and underscores the urgent need for standardization. Addressing these inconsistencies will enhance reproducibility, facilitate comparison across studies, and support the development of optimized liver preservation strategies.
Core Tip: Small animal liver machine perfusion models are essential for studying dynamic liver preservation in transplantation research. Rat liver perfusion provides a cost-effective and accessible platform, but currently no standardized protocols exist, limiting reproducibility and progress. This review highlights variations in existing studies, technical challenges, and limitations, emphasizing the urgent need for standardization. By summarizing key developments and system differences, it offers researchers practical insights to optimize perfusion strategies, improve reproducibility, and reduce animal use in future studies.
