Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jan 18, 2020; 10(1): 15-28
Published online Jan 18, 2020. doi: 10.5500/wjt.v10.i1.15
Machine perfusion in abdominal organ transplantation: Current use in the Netherlands
Elsaline Rijkse, Jan NM IJzermans, Robert C Minnee
Elsaline Rijkse, Jan NM IJzermans, Robert C Minnee, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015 GD, Netherlands
Author contributions: All authors contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing and approval of the final version.
Conflict-of-interest statement: No potential conflicts 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Robert C Minnee, FEBS, MD, PhD, Surgeon, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands. r.minnee@erasmusmc.nl
Received: July 31, 2019
Peer-review started: July 31, 2019
First decision: August 20, 2019
Revised: December 3, 2019
Accepted: December 19, 2019
Article in press: December 19, 2019
Published online: January 18, 2020
Processing time: 167 Days and 2.1 Hours
Abstract

Scarcity of donor organs and the increment in patients awaiting a transplant increased the use of organs from expanded criteria donors or donation after circulatory death. Due to the suboptimal outcomes of these donor organs, there is an increased interest in better preservation methods, such as ex vivo machine perfusion or abdominal regional perfusion to improve outcomes. This state-of-the-art review aims to discuss the available types of perfusion techniques, its potential benefits and the available evidence in kidney, liver and pancreas transplantation. Additionally, translational steps from animal models towards clinical studies will be described, as well as its application to clinical practice, with the focus on the Netherlands. Despite the lack of evidence from randomized controlled trials, currently available data suggest especially beneficial effects of normothermic regional perfusion on biliary complications and ischemic cholangiopathy after liver transplantation. For ex vivo machine perfusion in kidney transplantation, hypothermic machine perfusion has proven to be beneficial over static cold storage in a randomized controlled trial, while normothermic machine perfusion is currently under investigation. For ex vivo machine perfusion in liver transplantation, normothermic machine perfusion has proven to reduce discard rates and early allograft dysfunction. In response to clinical studies, hypothermic machine perfusion for deceased donor kidneys has already been implemented as standard of care in the Netherlands.

Keywords: Machine perfusion; Review; Kidney transplantation; Liver transplantation; Pancreas transplantation

Core tip: Scarcity of donor organs and the increment in waitlisted patients increased the use of organs from expanded criteria donors or donation after circulatory death donors. Due to suboptimal outcomes of these organs, there is an increased interest in dynamic preservation, such as ex vivo machine perfusion or abdominal regional perfusion to improve outcomes. This review discusses perfusion types, its potential benefits and the available evidence in kidney, liver and pancreas transplantation. Additionally, translational steps from animal models towards clinical studies will be described as well as its application to clinical practice, with as focus the Netherlands.