1. Graft repair during machine perfusion: a current overview of strategies.
- Author
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Broere R, Luijmes SH, de Jonge J, and Porte RJ
- Subjects
- Humans, Animals, Liver blood supply, Liver surgery, Treatment Outcome, Donor Selection, Tissue Donors supply & distribution, Anti-Inflammatory Agents, Perfusion methods, Perfusion instrumentation, Liver Transplantation adverse effects, Liver Transplantation methods, Graft Survival, Organ Preservation methods, Organ Preservation instrumentation
- Abstract
Purpose of Review: With changing donor characteristics (advanced age, obesity), an increase in the use of extended criteria donor (ECD) livers in liver transplantation is seen. Machine perfusion allows graft viability assessment, but still many donor livers are considered nontransplantable. Besides being used as graft viability assessment tool, ex situ machine perfusion offers a platform for therapeutic strategies to ameliorate grafts prior to transplantation. This review describes the current landscape of graft repair during machine perfusion., Recent Findings: Explored anti-inflammatory therapies, including inflammasome inhibitors, hemoabsorption, and cellular therapies mitigate the inflammatory response and improve hepatic function. Cholangiocyte organoids show promise in repairing the damaged biliary tree. Defatting during normothermic machine perfusion shows a reduction of steatosis and improved hepatobiliary function compared to nontreated livers. Uptake of RNA interference therapies during machine perfusion paves the way for an additional treatment modality., Summary: The possibility to repair injured donor livers during ex situ machine perfusion might increase the utilization of ECD-livers. Application of defatting agents is currently explored in clinical trials, whereas other therapeutics require further research or optimization before entering clinical research., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
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