Normothermic ex-situ liver preservation: the new gold standard.
OBJECTIVE
Normothermic machine perfusion of the liver (NMP-L) is a novel technology recently introduced into the practice of liver transplantation. This review recapitulates benefits of normothermic perfusion over conventional static cold storage and summarizes recent publications in this area.


RESULTS
The first clinical trials have demonstrated both safety and feasibility of NMP-L. They have shown that machine perfusion can entirely replace cold storage or be commenced following a period of cold ischaemia. The technology currently allows transplant teams to extend the period of organ preservation for up to 24 h. Results from the first randomized control trial comparing NMP-L with static cold storage will be available soon. One major advantage of NMP-L technology over other parallel technologies is the potential to assess liver function during NMP-L. Several case series have suggested parameters usable for liver viability testing during NMP-L including bile production and clearance of lactic acidosis. NMP-L allows viability testing of high-risk livers. It has shown the potential to increase utilization of donor organs and improve transplant procedure logistics.


CONCLUSIONS
NMP-L is likely to become an important technology that will improve organ preservation as well as have the potential to improve utilization of extended criteria donor livers.
aLiver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust bNational Institute for Health Research, Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom cLiver and HPB Unit, Apollo Navi Mumbai Hospital, Mumbai, India.
Richard W
RW
Laing
Hynek
H
Mergental
Darius F
DF
Mirza
D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*