The case for normothermic machine perfusion in liver transplantation

In recent years there has been growing interest in normothermic machine perfusion as a preservation method in liver transplantation. In most countries, due to a donor organ shortage, an unacceptable number of patients die whilst awaiting transplantation. In an attempt to increase the number of donor organs available, transplant teams are implanting a greater number of high-risk livers; including those from donors after circulatory death, older donors and with steatosis. Normothermic machine perfusion maintains the liver ex vivo on a circuit by providing oxygen and nutrition at 37°C. This permits extended preservation times, the ability to perform liver viability assessment and the potential for liver-directed therapeutic interventions during preservation. It is hoped that this technology may facilitate the enhanced preservation of marginal livers with improved post-transplant outcomes by reducing ischaemia reperfusion injury. Clinical trials have demonstrated its short-term superiority over cold storage in terms of early biochemical liver function and it is anticipated that it may result in increased organ utilisation, helping to reduce the number of waiting list deaths. However, further studies are required to demonstrate longer-term efficacy and the impact on biliary complications as well as further knowledge to exploit and maximise the potential of this exciting new technology. This article is protected by copyright. All rights reserved