“Resuscitation” of marginal liver allografts for transplantation with machine perfusion technology

Summary As the rate of medically suitable donors remains relatively static worldwide, clinicians have looked to novel methods to meet the ever-growing demand of the liver transplant waiting lists worldwide. Accordingly, the transplant community has explored many strategies to offset this deficit. Ad...

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Bibliographic Details
Published inJournal of hepatology Vol. 61; no. 2; pp. 418 - 431
Main Authors Graham, Jay A, Guarrera, James V
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.08.2014
Subjects
Adenosine Triphosphate - biosynthesis
Extended criteria donor
Extracorporeal Membrane Oxygenation
Fatty Liver - metabolism
Gastroenterology and Hepatology
Humans
Hypothermic
Lipid Peroxidation
Liver
Liver Transplantation - methods
Machine preservation
Marginal liver
Normothermic
Organ Preservation
Oxidative Phosphorylation
Perfusion
Perfusion - instrumentation
Reactive Oxygen Species - metabolism
Reperfusion Injury - prevention & control
Subnormothermic
Transplantation
Transplantation, Homologous
Extended criteria donor
Normothermic
Subnormothermic
Organ preservation
Perfusion
Liver
Machine preservation
Transplantation
Marginal liver
Hypothermic
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Summary:Summary As the rate of medically suitable donors remains relatively static worldwide, clinicians have looked to novel methods to meet the ever-growing demand of the liver transplant waiting lists worldwide. Accordingly, the transplant community has explored many strategies to offset this deficit. Advances in technology that target the ex vivo “preservation” period may help increase the donor pool by augmenting the utilization and improving the outcomes of marginal livers. Novel ex vivo techniques such as hypothermic, normothermic, and subnormothermic machine perfusion may be useful to “resuscitate” marginal organs by reducing ischemia/reperfusion injury. Moreover, other preservation techniques such as oxygen persufflation are explored as they may also have a role in improving function of “marginal” liver allografts. Currently, marginal livers are frequently discarded or can relegate the patient to early allograft dysfunction and primary non-function. Bench to bedside advances are rapidly emerging and hold promise for expanding liver transplantation access and improving outcomes.
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ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2014.04.019