Liver ex situ machine perfusion preservation: A review of the methodology and results of large animal studies and clinical trials

UMMS Affiliation

Transplant Division, Department of Surgery

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Animal Experimentation and Research | Clinical Trials | Hepatology | Surgery


Ex vivo machine perfusion (MP) is a promising way to better preserve livers prior to transplantation. Currently, no methodology has a verified benefit over simple cold storage. Before becoming clinically feasible, MP requires validation in models that reliably predict human performance. Such a model has been found in porcine liver, whose physiological, anatomical, and immunological characteristics closely resemble the human liver. Since the 1930s, researchers have explored MP as preservation, but only recently have clinical trials been performed. Making this technology clinically available holds the promise of expanding the donor pool through more effective preservation of extended criteria donor (ECD) livers. MP promises to decrease delayed graft function, primary nonfunction, and biliary strictures, which are all common failure modes of transplanted ECD livers. Although hypothermic machine perfusion (HMP) has become the standard for kidney ex vivo preservation, the precise settings and clinical role for liver MP have not yet been established. In research, there are 2 schools of thought: normothermic machine perfusion, closely mimicking physiologic conditions, and HMP, to maximize preservation. Here, we review the literature for porcine ex vivo MP, with an aim to summarize perfusion settings and outcomes pertinent to the clinical establishment of MP.

DOI of Published Version



Liver Transpl. 2017 May;23(5):679-695. doi: 10.1002/lt.24751. Link to article on publisher's site

Journal/Book/Conference Title

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

Related Resources

Link to Article in PubMed

PubMed ID