Hypothermic Machine Perfusion Of Liver Allografts: State Of The Art

Abstract Purpose of Review This review describes the clinical evidence supporting hypothermic machine perfusion (HMP) application in liver transplant (LT). Recent Findings Several randomized controlled trials (RCT) evaluating HMP, especially hypothermic oxygenated machine perfusion (HMP-O 2 or HOPE/D-HOPE) have demonstrated decreased rate of early allograft dysfunction (EAD) and ischemic cholangiopathy (IC) in LT recipients. The clinical benefit associated with HMP has allowed increased utilization of extended criteria brain death liver grafts (ECD-DBD) and donation after circulatory death (DCD) liver grafts. Recently, a portable HMP-O 2 circuit, which involves “oxygen pre-charging”, has been introduced in clinical practice in the United States of America (USA) to extend access and expand the portability of HMP. Additionally, measurement of flavin mononucleotide (FMN) levels during HMP allows intraoperative assessment of cumulative liver graft injury and prediction of post-LT function. Summary Given the robust clinical evidence supporting HMP application in clinical LT, stage is set for widespread adoption of HMP both at individual transplant centers and organ procurement organization level over the coming decade.