Liver preservation prior to transplantation: Past, present, and future

Abstract

Since Dr. Thomas Starzl performed the first series of successful liver transplants (LTs), important advances have been made in immunosuppression, operative techniques, and postoperative care. In 1988, Belzer’s group reported the first successful LT using the University of Wisconsin preservation solution (UW). Since then, UW has replaced EuroCollins solution and allowed prolonged and safer preservation of liver, kidney, and pancreas allografts, thus contributing to the improvement of transplant outcomes. Although UW is still considered the standard of care in the United States and in several countries worldwide, a recent meta-analysis revealed similar LT outcomes among UW, Celsior solution, and the Institut Georges Lopez-1 preservation solution, which were slightly superior to those obtained with histidine-tryptophan-ketoglutarate preservation solution. Dynamic preservation has been recently developed, and liver allografts are preserved mainly through the following methods: hypothermic machine perfusion, normothermic machine perfusion, and subnormothermic machine perfusion. Their use has the potential advantage of improving clinical results in LT involving extended criteria donor allografts. Although associated with increased costs, techniques employing machine perfusion of liver allografts have been considered clinically feasible. This editorial focuses on recent advances and future perspectives in liver allograft preservation.

RETRACTED ARTICLE: Heme oxygenase-1-modified bone marrow mesenchymal stem cells combined with normothermic machine perfusion to protect donation after circulatory death liver grafts

“…Liver transplantation is the most effective treatment for various end-stage liver diseases [1]. Donor graft quality can be preserved by static cold storage (SCS) using the University of Wisconsin (UW) solution [2,3]. This solution is of great clinical significance as it increases cold ischemic tolerance of organs and has become the most widely used gold standard preservation solution for liver transplantation.…”

The Role of Ex Situ Hypothermic Oxygenated Machine Perfusion and Cold Preservation Time in Extended Criteria Donation After Circulatory Death and Donation After Brain Death

“…Cold preservation is necessary to allow organ preservation. ( 8 ) However, prolonged static cold storage (SCS) could lead to graft damage with post‐LT complications and possible graft loss, especially in ECD grafts. ( 9 ) Although unavoidable, SCS could be limited improving transplant centers' coordination, reducing operative times, and through the application of advanced organ preservation techniques.…”

The Influence of Interdisciplinary Work towards Advancing Knowledge on Human Liver Physiology

“…On the other hand, given the imbalance between the high demand for a liver for transplantation and the actual liver donors, the requirements to donate have been expanded according to the “extended criteria donor”, where age and the presence of fatty liver are no longer used as exclusion parameters. Under these criteria, a few years ago an ex situ procedure consisting in the dynamic preservation of the liver previous to transplantation was adopted [ 64 ]. To date, it is possible using a normothermic machine perfusion to preserve the liver for >24 h up to 7 days.…”