Liver perfusion devices: how close are we to widespread application?

PURPOSE OF REVIEW: Ex-situ liver machine perfusion has been the focus of increasing interest over the past decade as a means to improve the quality of livers for transplantation and the applicability of liver transplantation in general. The present review aims to evaluate the experimental basis for liver machine perfusion and the significance of recent reports on its clinical application.

RECENT FINDINGS: Although liver machine perfusion has been studied experimentally over a range of temperatures, clinical liver transplant work that has been performed to date has been done using either hypothermic machine perfusion (0-12 °C), HMP or normothermic machine perfusion (35-38 °C, NMP). Both HMP and NMP have been studied clinically in the context of phase I trials demonstrating the feasibility of their application. It has also been shown through a small number of cases that NMP may serve as a useful means to evaluate initially discarded livers to determine viability for subsequent transplantation.

SUMMARY: Although initial clinical results are promising, higher level evidence is still needed to justify more widespread application of machine perfusion in human liver transplantation.