Hypothermic Machine Preservation of the Liver: State of the Art

Andrea Schlegel, Xavier Muller, Philipp Dutkowski, Andrea Schlegel, Xavier Muller, Philipp Dutkowski

Abstract

Purpose of review: In this review, we highlight which livers may benefit from additional treatment before implantation and describe the concept of hypothermic machine liver perfusion. Furthermore, we explain why cold oxygenated perfusion concepts could potentially lead to a breakthrough in this challenging field of transplantation. Accordingly, we summarize recent clinical applications of different hypothermic perfusion approaches.

Recent findings: The impact of end-ischemic, hypothermic liver perfusion in liver transplantation is currently assessed by two multicenter, randomized controlled trials. Recently, new applications of hypothermic perfusion showed promising results and recipients were protected from severe intrahepatic biliary complications, despite the use of very extended criteria grafts including donation after circulatory death livers.

Summary: Hypothermic machine liver perfusion is beneficial for high-risk livers and protects recipients from most feared complications. Importantly, such easy approach is currently implemented in several European centers and new markers obtained from perfusate may improve the prediction of liver function in the future.

Keywords: Hypothermic oxygenated perfusion (HOPE); Machine perfusion; Metabolic liver function; Mitochondria.

Conflict of interest statement

Compliance with Ethical StandardsThe authors declare that they have no conflict of interest.This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Mechanism of injury following ischemia/reperfusion and protection through hypothermic machine perfusion approaches
Fig. 2
Fig. 2
Examples of hypothermic oxygenated perfusion of liver grafts prior to implantation

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