Breaking the Ice: Early Clinical Results Using Hypothermic Machine Liver Preservation

Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used, however, to preserve kidneys for transplantation because it has demonstrated improved results over static cold storage (CS). As with other machine preservations methods, HMP provides continuous circulation of nutrients and metabolic substrates during the ex-vivo period. Over the last few years, several groups worldwide have been actively translating HMP into the clinical arena for liver transplantation. In particular, HMP has been used for livers of varying quality, including those recovered from extended criteria donors (ECD) and donation after cardiac death (DCD) donors. Reports to date have focused on recipient hospital based HMP during the latter portion of the cold ischemic period. While some variability exists in technique, all clinical series to date have reported improved outcomes with reductions in early allograft dysfunction, biliary complications and reduced hospital length of stay. These benefits, together with the development of innovative portable HMP devices and further adoption by more centers worldwide, have “broken the ice” for more widespread use of HMP and subsequent expanded elucidation of its benefits.