Normothermic Machine Perfusion-Improving the Supply of Transplantable Livers for High-Risk Recipients

Angus Hann, Anisa Nutu, George Clarke, Ishaan Patel, Dimitri Sneiders, Ye H Oo, Hermien Hartog, M Thamara P R Perera

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The effectiveness of liver transplantation to cure numerous diseases, alleviate suffering, and improve patient survival has led to an ever increasing demand. Improvements in preoperative management, surgical technique, and postoperative care have allowed increasingly complicated and high-risk patients to be safely transplanted. As a result, many patients are safely transplanted in the modern era that would have been considered untransplantable in times gone by. Despite this, more gains are possible as the science behind transplantation is increasingly understood. Normothermic machine perfusion of liver grafts builds on these gains further by increasing the safe use of grafts with suboptimal features, through objective assessment of both hepatocyte and cholangiocyte function. This technology can minimize cold ischemia, but prolong total preservation time, with particular benefits for suboptimal grafts and surgically challenging recipients. In addition to more physiological and favorable preservation conditions for grafts with risk factors for poor outcome, the extended preservation time benefits operative logistics by allowing a careful explant and complicated vascular reconstruction when presented with challenging surgical scenarios. This technology represents a significant advancement in graft preservation techniques and the transplant community must continue to incorporate this technology to ensure the benefits of liver transplant are maximized.

Original languageEnglish
Article number10460
JournalTransplant international
Publication statusPublished - 31 May 2022

Bibliographical note

Funding Information:
The funding provided for normothermic machine perfusion consumables generously donated by the Ann Fox Foundation, under the umbrella of University Hospital Birmingham Charities.

Funding Information:
– were created with . AH would like to acknowledge the funding received in the form of the Catherine Marie Enright research scholarship from the Royal Australasian College of Surgeons. YO would like to acknowledge the funding provided by the Sir Jules Thorn Biomedical Research Charity for his program of research.

Publisher Copyright:
Copyright © 2022 Hann, Nutu, Clarke, Patel, Sneiders, Oo, Hartog and Perera.


  • Cold Ischemia/adverse effects
  • Humans
  • Liver Transplantation/methods
  • Liver/surgery
  • Organ Preservation/methods
  • Perfusion/methods
  • preservation
  • normothermic machine perfusion
  • liver
  • retransplant
  • marginal
  • transplant

ASJC Scopus subject areas

  • Transplantation


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