title: Machine perfusion or cold storage in organ transplantation: indication, mechanisms, and future perspectives.
abstract: Most organs are currently preserved by cold storage (CS) prior to transplantation. However, as more so called marginal donor organs are utilized, machine perfusion has regained clinical interest. Recent studies have demonstrated advantages of pulsatile perfusion over CS preservation for kidney transplantation. However, it remains unclear whether there is a significant benefit of one preservation method over the other in general, or, whether the utilization of particular preservation approaches needs to be linked to organ characteristics. Proposed protective mechanisms of pulsatile perfusion remain largely obscure. It can be speculated that pulsatile perfusion may not only provide nutrition and facilitate the elimination of toxins but also trigger protective mechanisms leading to the amelioration of innate immune responses. Those aspects may be of particular relevance when utilizing grafts with suboptimal quality which may have an increased vulnerability to ischemia/reperfusion injury and compromised repair mechanisms. This review aims to enunciate the principles of organ perfusion and preservation as they relate to indication, aspects of organ protection and to highlight future developments.
authors.affiliation: Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Yuan
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Theruvath
authors.forename: Xupeng
authors.initials: X
authors.lastname: Ge
authors.forename: Bernhard
authors.initials: B
authors.lastname: Floerchinger
authors.forename: Anke
authors.initials: A
authors.lastname: Jurisch
authors.forename: Guillermo
authors.initials: G
authors.lastname: García-Cardeña
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
mesh_terms: D003080:Cold Temperature; D015925:Cryopreservation / Q000379:methods*; D005947:Glucose; D006801:Humans; D008353:Mannitol; D009926:Organ Preservation / Q000379:methods* / Q000639:trends; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods*; D011189:Potassium Chloride; D011343:Procaine; D011673:Pulsatile Flow
chemical_list: C039984:Bretschneider cardioplegic solution; D019188:Organ Preservation Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose