Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Ex Situ Liver Machine Perfusion as an Emerging Graft Protective Strategy in Clinical Liver Transplantation

the Dawn of a New Era

Nickkholgh, Arash MD1; Nikdad, Mohammadsadegh MD1; Shafie, Saeed MD1; Abbasi Dezfouli, Sepehr MD1; Mehrabi, Arianeb MD1; Eason, James D. MD2; Mas, Valeria R. PhD2; Maluf, Daniel G. MD2

doi: 10.1097/TP.0000000000002772

The disparity between the number of available donor livers and patients awaiting a liver transplant has led transplant centers to accept suboptimal livers. There has been no universally accepted tool to predict the posttransplant function of these organs to safely increase the donor pool, protect these livers against ischemia-reperfusion injury, or improve their quality before implantation. Ex situ liver machine preservation has emerged as a promising novel graft protective strategy in the field of liver transplantation, with remarkable ongoing research and evolving clinical trials within Europe and the United States. This technology has been shown to be safe and feasible in the clinical liver transplantation field, has shown to reduce liver ischemia-reperfusion injury, and has shown to decrease the graft discard rate compared with conventional static cold storage. This review focuses on the current status of ex situ machine preservation in clinical liver transplantation, describing the most important technical aspects with the emphasis on the findings of the most recent clinical studies.

1 Department of General, Abdominal and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.

2 Department of Surgery, University of Tennessee Health System, Memphis, TN.

Received 1 November 2018. Revision received 5 March 2019.

Accepted 7 April 2019.

A.N., A.M., and D.G.M. participated in research design. A.N., M.N., S.S., and S.A.D. participated in the performance of the research.A.N., M.N., and S.A.D. participated in data analysis. A.N. and M.N. participated in the writing of the paper.

The authors declare no funding or conflicts of interest.

Correspondence: Daniel. G. Maluf, MD, FAST, Transplant Institute, University of Tennessee Health System, 1211 Union St, Memphis, TN 38119. (

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.