"Resuscitation" of marginal liver allografts for transplantation with machine perfusion technology.
As the rate of medically suitable donors remains relatively static worldwide, clinicians have looked to novel methods to meet the ever-growing demand of the liver transplant waiting lists worldwide. Accordingly, the transplant community has explored many strategies to offset this deficit. Advances in technology that target the ex vivo "preservation" period may help increase the donor pool by augmenting the utilization and improving the outcomes of marginal livers. Novel ex vivo techniques such as hypothermic, normothermic, and subnormothermic machine perfusion may be useful to "resuscitate" marginal organs by reducing ischemia/reperfusion injury. Moreover, other preservation techniques such as oxygen persufflation are explored as they may also have a role in improving function of "marginal" liver allografts. Currently, marginal livers are frequently discarded or can relegate the patient to early allograft dysfunction and primary non-function. Bench to bedside advances are rapidly emerging and hold promise for expanding liver transplantation access and improving outcomes.
Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY 10032, USA.
Jay A
JA
Graham
Center for Liver Disease and Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY 10032, USA. Electronic address: jjg46@cumc.columbia.edu.
James V
JV
Guarrera
D000255:Adenosine Triphosphate / Q000096:biosynthesis; D015199:Extracorporeal Membrane Oxygenation; D005234:Fatty Liver / Q000378:metabolism; D006801:Humans; D015227:Lipid Peroxidation; D016031:Liver Transplantation / Q000379:methods*; D009926:Organ Preservation; D010085:Oxidative Phosphorylation; D010477:Perfusion / Q000295:instrumentation*; D017382:Reactive Oxygen Species / Q000378:metabolism; D015427:Reperfusion Injury / Q000517:prevention & control; D014184:Transplantation, Homologous
D017382:Reactive Oxygen Species; D000255:Adenosine Triphosphate
Extended criteria donor; Hypothermic; Liver; Machine preservation; Marginal liver; Normothermic; Organ preservation; Perfusion; Subnormothermic; Transplantation