title: Extracorporeal machine liver perfusion:  are we warming up?
abstract: OBJECTIVE
  Recently, considerable focus has been placed on the use of hypothermic perfusion ex vivo in abdominal organ transplant. Herein, we discuss the appropriateness of using this modality to preserve livers, in particular those of suboptimal quality, and whether perfusing at warmer temperatures in this context may, in fact, be better.
  
  
  RESULTS
  Hypothermic perfusion (0-4°C) appears to improve the hepatocellular energy charge and achieve adequate results in normal livers. However, its use for the preservation of suboptimal grafts may lead to significant endothelial and Kupffer cell injury that is incompatible with survival. Studies on the perfusion of suboptimal livers at higher temperatures, on the contrary, indicate that results improve as temperatures approach 37°C, provided that the oxygen supply during perfusion is adequate.
  
  
  CONCLUSIONS
  Normothermic perfusion provides oxygen and other metabolic substrates under physiological conditions; in liver transplant, it appears to be the best option to improve the viability of suboptimal organs.
authors.affiliation: Hepatobiliary and Liver Transplant Surgery, Liver Transplant Unit, Department of Surgery, Institut de Malaties Digestives, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Hessheimer
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
authors.forename: Juan C
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D006801:Humans; D008099:Liver; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D013696:Temperature; D019737:Transplants