title: Liver ex situ machine perfusion preservation: A review of the methodology and results of large animal studies and clinical trials.
abstract: Ex vivo machine perfusion (MP) is a promising way to better preserve livers prior to transplantation. Currently, no methodology has a verified benefit over simple cold storage. Before becoming clinically feasible, MP requires validation in models that reliably predict human performance. Such a model has been found in porcine liver, whose physiological, anatomical, and immunological characteristics closely resemble the human liver. Since the 1930s, researchers have explored MP as preservation, but only recently have clinical trials been performed. Making this technology clinically available holds the promise of expanding the donor pool through more effective preservation of extended criteria donor (ECD) livers. MP promises to decrease delayed graft function, primary nonfunction, and biliary strictures, which are all common failure modes of transplanted ECD livers. Although hypothermic machine perfusion (HMP) has become the standard for kidney ex vivo preservation, the precise settings and clinical role for liver MP have not yet been established. In research, there are 2 schools of thought: normothermic machine perfusion, closely mimicking physiologic conditions, and HMP, to maximize preservation. Here, we review the literature for porcine ex vivo MP, with an aim to summarize perfusion settings and outcomes pertinent to the clinical establishment of MP. Liver Transplantation 23 679-695 2017 AASLD.
authors.affiliation: Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA.
authors.forename: Hazel
authors.initials: H
authors.lastname: Marecki
authors.affiliation: Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA.
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Henri G
authors.initials: HG
authors.lastname: Leuvenink
authors.affiliation: Center of Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Korkut
authors.initials: K
authors.lastname: Uygun
authors.affiliation: Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA.
authors.forename: Paulo N
authors.initials: PN
authors.lastname: Martins
mesh_terms: D000818:Animals; D006801:Humans; D008099:Liver; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*