Machine Perfusion Plus for Extended Criteria Donor Liver Grafts: Making Every Liver Count
Zhoucheng Wang,
Jack Martin,
Jiongjie Yu,
Kai Wang,
Kourosh Saeb-Parsy,
Xiao Xu
Affiliations
Zhoucheng Wang
Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou 310006, China
Jack Martin
Department of Surgery, University of Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK; Department of Surgery, Cambridge University Hospitals & NHS Foundation Trust, Cambridge CB2 2QQ, UK
Jiongjie Yu
Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou 310006, China
Kai Wang
Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China
Kourosh Saeb-Parsy
Department of Surgery, University of Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK; Department of Surgery, Cambridge University Hospitals & NHS Foundation Trust, Cambridge CB2 2QQ, UK; Corresponding authors.
Xiao Xu
Zhejiang University School of Medicine, Hangzhou 310058, China; Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China; Corresponding authors.
Transplantation represents the most effective treatment for end-stage liver diseases but is limited by the shortage of healthy donor organs. Extended criteria donor (ECD) liver grafts are increasingly utilized in clinical practice to mitigate this challenge. However, impaired ischemic tolerance of these grafts jeopardizes organ viability during cold storage. Machine perfusion (MP) was designed to improve organ preservation and reduce posttransplant complications. Nevertheless, it is increasingly evident that MP alone may not preserve ECD grafts optimally. Increasing emphasis has thus been placed on modified MP strategies, including the use of different perfusates, modified perfusion modalities, and different therapeutic interventions. Here, we introduce a novel term, “MP Plus,” denoting these additional strategies that are designed to restore organ function and potentially enable regeneration of ECD grafts. In this review, we summarize the existing and potential modified MP strategies and discuss their advantages in reconditioning different ECD grafts in clinical settings.
