Salvage of an Octogenarian Liver Graft Using Normothermic Perfusion: A Case Report

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

“…It is essential not only to perform an adequate selection of donors and recipients but also to pursue an optimal peritransplant management in order to maintain a normal circulation and oxygenation in the graft. Normothermic machine perfusion (NMP) is a novel technique for preservation of liver grafts with the potential to reduce ischemia/reperfusion injury and improve hemodynamics, potentially “resuscitating” marginal organs . The use of NMP results in smooth reperfusion achieving a more physiological stability, with lesser need of pressor support and blood product transfusion .…”

“…Normothermic machine perfusion (NMP) is a novel technique for preservation of liver grafts with the potential to reduce ischemia/reperfusion injury and improve hemodynamics, potentially "resuscitating" marginal organs. (50)(51)(52)(53) The use of NMP results in smooth reperfusion achieving a more physiological stability, with lesser need of pressor support and blood product transfusion. (51) Multicenter trials are underway to clearly establish the potential utility of these new tools.…”

Perfusion machines and hepatocellular carcinoma: a good match between a marginal organ and an advanced disease?

“…No difference in terms of 30 days and 6 months graft survival, AST peak within 7 days, PNF, EAD, major complication and 6 months biliary complications was found. Nevertheless, ICU and hospital stay were longer (16 vs. 4 (59,73,82), all using DBD donors. The first group reported the use of ex situ NMP as salvage treatment for an 83-, 73-and 33-year-old donor, respectively, with insufficient perfusion at the time of procurement or following prolonged cardiocirculatory arrest.…”

“…Several other components may be added depending on transplant group preferences (e.g., antibiotics, heparin, insulin, etc.). Operative conditions are generally set up at a temperature of 37 ℃ and the target pressures in the hepatic artery (HA) and portal vein (PV) of 60 and 8 mmHg, respectively (72,73).…”

Role of perfusion machines in the setting of clinical liver transplantation: A qualitative systematic review

“…Since then, multiple experiences have been reported worldwide, fostering high expectations concerning the following implementation of MPs into clinical practice . However, several obstacles, as the necessity of finding objective MP‐related variables to select grafts suitable for LT, still stand.…”