title: Normothermic liver preservation: a new paradigm?
abstract: Despite increasing donor numbers, waiting lists and pre-transplant mortality continue to grow in many countries. The number of donor organs suitable for liver transplantation is restricted by cold preservation and ischemia-reperfusion injury (IRI). Transplantation of marginal donor organs has led to renewed interest in new techniques which have the potential to improve the quality of preservation, assess the quality of the organ and allow repair of the donor organ prior to transplantation. If successful, such techniques would not only improve the outcome of currently transplanted marginal livers, but also increase the donor pool. Experimental evidence suggests that preservation under near physiological conditions of temperature and oxygenation abrogates IRI. Normothermic perfusion maintains the organ in a physiological state, avoiding the depletion of cellular energy and the accumulation of waste products, which occurs with static cold storage. It enables viability assessment prior to transplantation thereby reducing the risk of transplanting inherently marginal organs. Here we review the use of normothermic machine perfusion as a means of organ preservation.
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Reena
authors.initials: R
authors.lastname: Ravikumar
authors.affiliation: Groningen Transplant Center, University Medical Center, Groningen, The Netherlands.
authors.forename: Henri
authors.initials: H
authors.lastname: Leuvenink
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
mesh_terms: D003080:Cold Temperature; D004867:Equipment Design; D005234:Fatty Liver / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000295:instrumentation / Q000379:methods*; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion; D012306:Risk; D013696:Temperature; D009927:Tissue and Organ Procurement
chemical_list: D019188:Organ Preservation Solutions
keywords: machine perfusion; normothermic liver perfusion; organ preservation