Long-term machine perfusion: a new tool in the box to increase available liver grafts

Abstract

Liver diseases are becoming more prevalent in the western world. At this moment, the only viable therapy for end-stage liver diseases is liver transplantation. Liver transplantation, as first successfully performed by Dr Thomas Starzl in 1967, has made it possible for a patient with severe end-stage liver disease to recover. However, the need for liver transplantations has been rising over the years, with now over 30.000 transplantations performed worldwide every year. The number of patients requiring transplantation is rising while there are not enough donors, leading to long waiting lists. During the past decades, major advances have been made to fill this gap of available donors. A recent advance is the ability to sustain a liver outside of the body for 7 days. This new technique, long-term machine perfusion, could open up exciting new treatment possibilities: extended duration of long-term machine perfusion could enable genetic modulation on perfused livers, regeneration of partial livers or bioengineering combined with liver perfusion. This review explains how long-term machine perfusion works and discusses the possibilities this technique would enable, looking at already existing techniques in ongoing research and hypothesize how long-term machine perfusion would aid in these techniques.