title: Machine perfusion preservation of the liver: a worthwhile clinical activity?
abstract: OBJECTIVE
  Although successful machine perfusion procedures of the liver were first performed almost four decades ago, technical and logistical constraints have prevented general acceptance. Interest in the procedure has recently been renewed due to its potential to resuscitate marginal organs. This review describes experimental and clinical liver hypothermic machine perfusion studies and current developments.
  
  
  RESULTS
  Experimental studies have shown that oxygenated hypothermic machine perfusion provides a complete washout and can restore parenchymal energy status, a phenomenon of particular importance in preservation of livers from compromised donors. Additionally, perfusion of the hepatic artery can prevent ischemic-type biliary lesions. Short-term and continuous hypothermic machine perfusion prior to or after cold storage preservation have proven more effective than cold storage alone.
  
  
  CONCLUSIONS
  The benefits of hypothermic machine perfusion for both heart-beating and nonheart-beating liver grafts seem promising in terms of expanding the donor pool. As liver hypothermic machine perfusion systems are not yet commercially available, the process is currently only clinically used for kidney grafts. Clinical application appears feasible in the near future as new, easy-to-use systems and solutions are currently under development.
authors.affiliation: Department of Surgery, Surgical Laboratory, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marie-Claire Jm
authors.initials: MJ
authors.lastname: Schreinemachers
authors.forename: Benedict M
authors.initials: BM
authors.lastname: Doorschodt
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik