Ex situ machine preservation of donor livers for transplantation: HOPE for all?

Abstract

Liver transplantation has become a victim of its own success. Shortage of organs is limiting access to this life-saving treatment. Despite this, many organs are refused for transplantation based on suboptimal quality and risk of early graft failure. Most deceased donor livers that are currently declined for transplantation are functioning well in the donor, but this can change after transplantation due to ischaemia–reperfusion injury that occurs during the procurement, preservation, and transplant procedures. The current standard of donor organ preservation is static cold ischaemic preservation after flush-out with a preservation solution. Although this method is sufficient for organs of optimal quality, it does not provide adequate protection against ischaemia–reperfusion injury in suboptimal donor organs. In particular, livers from donation after circulatory death (DCD) donors are more prone to substantial ischaemia–reperfusion injury that will result in graft-related complications after transplantation, such as primary graft non-function and non-anastomotic stricture (NAS) of the donor bile ducts. Both types of complication are more frequent after transplantation of DCD organs compared with donation after brain death (DBD) livers ¹.