Current and Future Applications of Machine Perfusion and Other Dynamic Preservation Strategies in Liver Transplantation

Machine perfusion (MP) techniques, which simulate physiological conditions to allow for the assessment and preservation of organ viability, are currently applied in various solid organ transplantation fields. Owing to the growing demand for liver transplants and the scarcity of available donor livers, MP offers a practical solution for recovering high-risk grafts and increasing the number of potentially usable donor organs. Furthermore, testing and administering novel therapies to allografts may also become advantageous. Therefore, it has become essential to examine the role of MP in liver transplantation (LT), identify the challenges in its application, and determine future research directions in this field. This review summarizes the findings from clinical trials on hypothermic MP, normothermic MP (NMP), explores novel dynamic preservation approaches, such as normothermic regional perfusion, ischemia-free transplantation, combinations of MP techniques, and long-term NMP, addresses the obstacles to standardizing MP protocols, and highlights the critical role of clinical trials in validating various aspects of the perfusion process.