CONTROVERSIES IN ORGAN TRANSPLANTATION: Edited by Joseph F. MaglioccaHypothermic machine perfusion for liver graft preservationAmin, Arpit; Panayotova, Guergana; Guarrera, James V. Author Information Division of Abdominal Transplant Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Correspondence to James V. Guarrera, MD, FACS, Professor and Interim Chair of Surgery, Chief of Transplant and HPB Surgery, 185 South Orange Avenue, Medical Science Building, Room G-506, Newark, NJ 07103, USA. Tel: +1 973 972 5045; e-mail: [email protected] Current Opinion in Organ Transplantation 27(2):p 98-105, April 2022. | DOI: 10.1097/MOT.0000000000000973 Buy Metrics Abstract Purpose of review Ex-vivo machine perfusion has emerged as a promising alternative to static cold storage (SCS) for preservation of liver grafts over the last decade. This review describes the mechanistic benefits associated with hypothermic machine perfusion (HMP) for preservation of liver grafts and highlights clinical outcomes of liver transplantation using HMP technology. Recent findings Over the last decade, several single-centre studies have shown decreased biliary complications, decreased early allograft dysfunction (EAD) rates and improved patient survival in liver transplant recipients after application of HMP for liver graft preservation. This has led to initiation of prospective, multicentre, randomized controlled trials (RCTs) in both Europe and North America focused on clinical outcomes in liver transplant recipients using HMP-preserved liver grafts. In addition, recent single-centre studies have shown the utility of perfusate biomarker analysis during HMP in predicting EAD after liver transplantation. Summary HMP technology has potential to increase the available donor liver organ pool for liver transplant recipients and improve clinical outcomes after liver transplantation. Broader clinical application of HMP in resuscitation and preservation of liver grafts is anticipated over the next decade once regulatory, logistical and financial challenges are overcome. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.