Machine perfusion strategies in liver transplantation

摘要

Machine perfusion is a hot topic in liver transplantation and several new perfusion conceptsare currently developed. Prior to introduction into routine clinical practice, however, such perfusionapproaches need to demonstrate their impact on liver function, post-transplant complications, utilizationrates of high-risk organs, and cost benefits. Therefore, based on results of experimental and clinical studies,the community has to recognize the limitations of this technology. In this review, we summarize currentperfusion concepts and differences between protective mechanisms of ex- and in-situ perfusion techniques.Next, we discuss which graft types may benefit most from perfusion techniques, and highlight the currentunderstanding of liver viability testing. Finally, we present results from recent clinical trials involvingmachine liver perfusion, and analyze the value of different outcome parameters, currently used as endpointsfor randomized controlled trials in the field.