title: Liver protection strategies in liver transplantation.
abstract: BACKGROUND
  Liver transplantation is the therapy of choice for patients with end-stage liver diseases. However, the gap between the low availability of organs and high demand is continuously increasing. Innovative strategies for organ protection are necessary to expand donor pool and to achieve better outcomes for liver transplantation. The present review analyzed and compared various strategies of liver protection.
  
  
  METHODS
  Databases such as PubMed, Embase and Ovid were searched for the literature related to donor liver protection strategies using following key words: "ischemia reperfusion injury", "graft preservation", "liver transplantation", "machine perfusion" and "conditioning". Of the 146 studies identified, only those with cutting edge strategies were analyzed.
  
  
  RESULTS
  A variety of therapeutic approaches were proposed to alleviate graft ischemia/reperfusion injury, which included static cold storage, machine perfusion (hypothermic, normothermic and subnormothermic), manual conditioning (pre, post and remote), and pharmacological conditioning. Evidences from animal experiments and clinical trials suggested that all these strategies could potentially protect liver graft; however, their clinical applications are limited partially due to their own disadvantages.
  
  
  CONCLUSIONS
  There are a plenty of methods suggested to decrease the degree of donor liver transplantation-related injury. However, none of these approaches is perfect in clinical practice. More translational researches (molecular and clinical studies) are needed to improve the techniques in liver graft protection.
authors: Key Laboratory of Combined Multi-organ Transplantation, Ministry of Health; Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. shusenzheng@zju.edu.cn.
authors: Jun-Jun
authors: JJ
authors: Jia
authors: Jian-Hui
authors: JH
authors: Li
authors: Li
authors: L
authors: Jiang
authors: Bin-Yi
authors: BY
authors: Lin
authors: Li
authors: L
authors: Wang
authors: Rong
authors: R
authors: Su
authors: Lin
authors: L
authors: Zhou
authors: Shu-Sen
authors: SS
authors: Zheng
mesh_terms: D000818:Animals; D050377:Cold Ischemia / Q000009:adverse effects; D019610:Cytoprotection; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D057775:Ischemic Postconditioning; D019194:Ischemic Preconditioning; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
chemical_list: D019188:Organ Preservation Solutions