Liver preservation: is there anything new yet?
OBJECTIVE
To provide an update on recent developments in liver preservation through a comprehensive review of the literature.


RESULTS
Comparisons of the available preservation solutions for liver transplantation based on recent trials suggest clinical equivalence. The debate continues regarding risk of biliary-tract complications. Development of new preservation solutions and agents that target specific mechanisms of steatotic and donors after cardiac death pathophysiology is showing promise in a variety of preclinical and clinical studies. Early clinical results of ischemic preconditioning are conflicting and so there is the need for additional clinical studies. The most important developments have been in the machine perfusion of the liver. New portable perfusion systems have shown promise in preclinical studies and may allow rapid evolution of clinical liver machine perfusion. The first human clinical trial is well underway with results showing safety and improved efficacy of preservation of transplanted human liver allografts.


CONCLUSIONS
Liver preservation is in a period of rapid advance. In the future, a multifaceted liver-preservation strategy that integrates pharmacologic agents and hypothermic machine perfusion is likely to minimize organ injury and maximize patient outcomes. An ongoing challenge is to increase the number of innovations entering prospective and randomized clinical trials.
Guarrera
James V
JV
Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032 USA. jjg46@columbia.edu
Karim
Niaz A
NA
D002986:Clinical Trials as Topic; D006801:Humans; D008099:Liver; D016031:Liver Transplantation; D009926:Organ Preservation / Q000639:trends*; D019188:Organ Preservation Solutions; D010477:Perfusion
D019188:Organ Preservation Solutions