Volume 88 - 2025 - Fasc.3 - Reviews
Dynamic liver preservation: current evidence and future challenges
Background and Study Aims: Liver transplantation (LT)
is limited by organ shortage. Dynamic preservation (DP)
techniques have rapidly become the standard of care in liver
graft preservation, particularly for extended criteria donors
(ECD). This study reviews the clinical applications and future
potential of various DP techniques in LT.
Patients and Methods: A literature review was conducted
using Medline (PubMed) to identify relevant studies on DP
techniques, including normothermic machine perfusion
(NMP), hypothermic oxygenated perfusion (HOPE), and
normothermic regional perfusion (NRP).
Results: A growing number of high-impact studies support
the clinical implementation of MP techniques. NMP maintains
the organ metabolically active, enabling real-time graft
viability assessment through markers of function and injury.
When initiated at the donor hospital, NMP helps reduce or
even eliminate ischemia-reperfusion injury (IRI). HOPE, on
the other hand, mitigates IRI by supporting mitochondrial
recovery, with flavin mononucleotide serving as a reliable
surrogate marker of graft function. Importantly, both NMP
and HOPE allow for safely extended preservation times,
improving LT logistics and avoiding the need for nighttime
procedures. NRP restores oxygenated blood flow in donation
after circulatory death donors, reducing biliary complications
and improving graft outcomes compared to rapid organ
recovery. Emerging strategies, such as controlled oxygenated
rewarming, combine HOPE and NMP to sequentially optimize
graft preservation and assessment.
Conclusions: DP has revolutionized liver preservation,
providing superior outcomes compared to static cold storage,
particularly for ECD. Clarity and consensus are needed
regarding the definition of clinically relevant endpoints
to broaden the applicability of study results on DP.