Liver Preservation with Extracorporeal Perfusion

The increasing utilization of extended criteria donors (ECD) to overcome the demand of liver grafts and decrease the mortality on the waiting list for transplant, has led the transplant community to explore alternative preservation techniques to minimise the ischaemia reperfusion injury (IRI) associated to ECD, decrease the risk of complications and achieve similar outcomes. These new alternative preservation techniques have emerged in recent years, involving ex situ but also in situ machine perfusion, and it is predicted that it may become the standard of care in the near future. The advantage of these techniques is that they can preserve and provide oxygen to the donor liver, they can recondition and improve the donor organ quality, and in normothermic conditions they can provide a functional assessment and viability of the graft to help the surgeons in the decision making whether to utilize that liver. Other advantages are the potential to improve transplant logistics with prolonged preservation times and also the possibility of using therapeutic strategies during the perfusion to improve their quality or further minimise IRI. Current research is being undertaken using these different perfusion techniques alone or in combination to minimize the ischemic damaged suffered during procurement and cold preservation of the donor livers, to increase the donor pool and decrease the discard rates of ECD livers that could be safely transplanted.