Changing liver utilization and discard rates in clinical transplantation in the ex-vivo machine preservation era

A recent review article by Azizieh et al. focused on the implementation of ex-vivo machine preservation and how it might change the perception of organ acceptability.  By focusing on machine perfusion, they explored the effects of the different modalities on outcomes and look at how MP has contributed to modifying surgeon acceptance criteria and the role in decreasing discards.

They reviewed the most common reasons for organ discard, such as:

  • Extended criteria donors (ECD), Standard criteria donors (SCD) and donors after circulatory death (DCD)
  • Advanced age
  • Steatosis, and
  • Donor risk index

They then looked at the strategies for preserving these suboptimal organs, such as:

  • Reducing ischemia reperfusion injury (IRI)
  • Optimal preservation solutions, and
  • Reducing ischemia time

Finally, they reviewed the different types of machine perfusion and their implications in graft utilization, including hypothermic machine perfusion, subnormothermic machine perfusion and normothermic machine perfusion.  They noted that since machine perfusion is known to reduce IRI and allow the option to deliver targeted therapeutics, it is theoretically our best option to reduce the liver discard rate.  Overall, they concluded that machine perfusion seems to be the ideal tool to improve grafts deemed unusable by combining old concepts with new technology and discovery.

Read the full article here:

Tagged In:

DCD, ECD, HMP, Liver

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