ORGAN PRESERVATION AND PROCUREMENT: Edited by Paolo MuiesanIs extracorporeal hypothermic machine perfusion of the liver better than the ‘good old icebox’?Bae, Coney; Henry, Scot D.; Guarrera, James V.Author Information Molecular Therapies and Organ Preservation Research Laboratory, Division of Abdominal Organ Transplantation, Department of Surgery, Columbia University Medical Center, New York, USA Correspondence to James V. Guarrera, MD, FACS, Assistant Professor of Surgery, Surgical Director of Adult Liver Transplantation, Division of Abdominal Organ Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH 14 center, Room 202, New York, NY 10032, USA. Tel: +1 212 305 4199; fax: +1 212 305 8710; e-mail: [email protected],[email protected] Current Opinion in Organ Transplantation: April 2012 - Volume 17 - Issue 2 - p 137-142 doi: 10.1097/MOT.0b013e328351083d Buy Metrics Abstract Purpose of review To underscore the advantages of hypothermic machine perfusion (HMP) in light of the recent discoveries. Recent findings The phase I clinical trial of liver HMP has suggested superiority over static cold storage (SCS) preservation. The liver transplant arena has gained more sophisticated insights into the molecular mechanism and biomechanical understanding behind the benefits of HMP. Its ability to attenuate ischemia-reperfusion injury translates to reduction in ischemia-reperfusion injury with improved early allograft function. HMP has the potential to predict graft function as well as enable resuscitation of grafts from extended criteria donors. Targeted therapeutic interventions via HMP will further contribute to optimal preservation and reconditioning of the allografts. Summary HMP's advantages do not merely derive from its mechanical forte in maintaining the microvasculature patent. It is also a versatile clinical tool with the ability to deliver metabolic substrates, antioxidants and therapeutic agents to the ex-vivo graft, dilution of waste products generated by inefficient or anaerobic respiration, intraoperative ex-vivo assessment and prediction of the graft's future performance posttransplantation. With demonstrated superiority over SCS, HMP holds promise for expanding the donor pool and becoming the gold standard for liver preservation. © 2012 Lippincott Williams & Wilkins, Inc.