The innovation and clinical application of ischemia-free organ transplantation

Abstract

The incidence rate of liver cancer is increasing year by year globally. Liver transplantation has become one of the therapeutic methods for patients with liver cancer. In the past, ischemia-reperfusion injury (IRI) was unavoidable in liver transplantation, compromising recipient and graft survival. At the same time, the imbalance between the supply and demand of organs limits the use of transplantation in patients with liver cancer. Recently, advances have been made in machine perfusion techniques to reduce graft IRI. However, none of the techniques can completely abrogate graft IRI. In 2017, the concept of ischemia-free organ transplantation (IFOT) was proposed, and our group conducted the first case of ischemia-free liver transplantation (IFLT). We then extended the concept of IFOT to kidney transplantation in 2018 and to heart transplantation in 2021. Here, we review the history, strengths, and weaknesses, and the future direction of IFOT, particularly in patients with liver cancers.

Keywords

• liver cancer
• ischemia-reperfusion injury
• ischemia-free organ transplantation
• ischemia-free liver transplantation
• extended criteria donor