End-stage liver diseases are nowadays effectively treated by transplantation of the affected liver. The transplantation procedure includes procurement of the liver from the donor and subsequently transport of the liver from donor to receiving patient (Chapter 1). To bridge the timespan of transport between donor operation and actual implantation of the organ in the receiving patient, the liver has to be optimally stored and preserved in order to maintain viability of the organ. To date, the conventional method of preservation is the Cold Storage (CS) preservation technique. The CS method implies a single flush of the liver in situ with an ice-cold preservation solution to wash-out remaining blood and immediately cool the organ. Subsequently, the liver is stored in a plastic bag containing cold preservation solution and transported in a cooling box filled with melting ice to maintain a lowered metabolism during hypothermia (0-4±C). The University of Wisconsin cold storage (UW-CS) solution is nowadays the golden standard in preservation solutions. Although CS preservation shows good results in preserving livers from brain-dead donors, who have an intact circulation, expansion of the donor pool with an important potential group of non-heart-beating donors (NHBDs), after cardiac arrest, requires improved preservation techniques. Hypothermic machine perfusion (HMP) is a dynamic preservation method that actively perfuses the liver. With HMP a continuous supply of oxygen and removal of waste products is obtained which improves preservation outcome. Especially marginal, older and NHB donor livers will benefit from this improved quality. The aim of this thesis was to develop a hypothermic machine perfusion system which is able to optimally preserve donor livers.
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