Overview on the human liver preservation by means of ex-vivo perfusion: A view of the state-of-the-art

Abstract

SCS (Static Cold Storage) is the gold standard for organ preservation, while HMP (Hypothermic Machine Perfusion) was initially proposed by Belzer in the 60’s. NMP (Normothermic Machine Perfusion) avoids cold ischemia, preserves and monitors graft function in real time by assessing bile production. The present work aims to summarize studies with human organs and their outcomes by using various parameters. A review of the literature was made and 73 articles were collected; 15 were literary reviews, and 58 were experimental trials, from which eight using human organs, 12 used porcine, and 39 used rat organs. From the eight works with human livers, five used HMP, while two used SNMP and one used NMP, all of which showed an improvement in the graft function and lesion assessment markers. As to the solutions for preservation, the majority used the UW (University of Wisconsin) solution, while only one used a red blood cell-based solution. The duration of perfusion varied from 30 minutes to 24 hours. The use of extended criteria organs might be an alternative for patients awaiting transplantation. Perfusion machines and their several settings are increasingly present in the solid organ transplant context, and it will be decisive to reduce the waiting lists for transplants. The development of practical perfusion machines for human organs is becoming a reality, and it represents the future for liver transplantation. An ever-growing amount of models and protocols are forecasted in the following years.