Hypothermic Machine Preservation in Liver Transplantation Revisited: Concepts and Criteria in the New Millennium

Abstract

To overcome the present shortage of liver donors by expansion of the existing donor pool and possibly lengthening of the storage time, hypothermic machine perfusion of the liver as a dynamic preservation method is revisited. The three most important aspects are defined to be the type of preservation solution, the characteristics of perfusion dynamics, and the oxygen supply. Reviewing hypothermic liver machine perfusion experiments, the University of Wisconsin machine preservation solution is the solution most used. It is also found that nothing conclusive can be said about the optimal perfusion characteristics, since either perfusion pressure or perfusion flow is reported. The best estimation is perfusion of the liver in a physiological manner, i.e. pulsatile arterial perfusion and continuous portal venous perfusion. The applied pressures could be chosen to be somewhat lower than physiological pressures to prevent possible endothelial cell damage. Oxygen supply is necessary to achieve optimal preservation of the liver. The minimal amount of partial oxygen pressure required is inversely related to the normalized flow. Incorporating these features in a system based on existing standard surgical and organ sharing procedures and which is able to work stand-alone for 24 h, weighing less than 23 kg, could successfully implement this technique into every day clinical practise.

Role of perfusion medium, oxygen and rheology for endoplasmic reticulum stress-induced cell death after hypothermic machine preservation of the liver

“…To make optimum use of organs harvested after cardiac arrest of the donor, preservation techniques like continuous machine perfusion were proposed, aiming to reverse deleterious priming of the graft by means of ex vivo tissue oxygenation immediately after harvest [7][8][9].…”

Organ Preservation: Current Concepts and New Strategies for the Next Decade

“…To overcome the present shortage of donors by expansion of the existing donor pool and possibly lengthening of the storage time HMP as a dynamic preservation method is an alternative [30]. Grafts from NHBDs are thought to be best preserved by HMP.…”

Rescue of the Cold Preserved Rat Liver by Hypothermic Oxygenated Machine Perfusion

“…The benefit of oxygenated machine perfusion applied during the entire duration of storage is well established (20)(21)(22). However, this approach has not gained wide popularity due to its complexity and the need for transportable perfusion devices.…”