The dawn of liver perfusion machinesDetelich, Danielle; Markmann, James, F.Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 151–161 doi: 10.1097/MOT.0000000000000500 LIVER TRANSPLANTATION: Edited by R. Mark Ghobrial Buy Abstract Author InformationAuthors Article MetricsMetrics Purpose of review Despite high demand, a severe shortage of suitable allografts limits the use of liver transplantation for the treatment of end-stage liver disease. The transplant community is turning to the utilization of high-risk grafts to fill the void. This review summarizes the reemergence of ex-vivo machine perfusion for liver graft preservation, including results of recent clinical trials and its specific role for reconditioning DCD, steatotic and elderly grafts. Recent findings Several phase-1 clinical trials demonstrate the safety and feasibility of machine perfusion for liver graft preservation. Machine perfusion has several advantages compared with static cold storage and may provide superior transplantation outcomes, particularly for marginal grafts. Ongoing multicenter trials aim to confirm the results of preclinical and pilot studies and establish the clinical utility of ex-vivo liver machine perfusion. Summary Mounting evidence supports the benefits of machine perfusion for preservation of liver grafts. Thus, machine perfusion is a promising strategy to expand the donor pool by reconditioning and assessing viability of DCD, elderly and steatotic grafts during the preservation period. Additionally, machine perfusion will serve as a platform to facilitate graft intervention and modification to further optimize marginal grafts. Division of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA Correspondence to James F. Markmann, Division of Transplant Surgery, Massachusetts General Hospital, 55 Fruit Street, White 517, Boston, MA 02114, USA. Tel: +1 617 643 4533; e-mail: firstname.lastname@example.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.