Long-term ex situ normothermic liver perfusion

Because of organ shortage many patients die awaiting liver transplantation. Main reasons for the increasing gap between supply and demand are deteriorating organ quality and significant limitations related to current organ preservation techniques. Long-term perfusion of livers provides sufficient time for graft quality assessment, mitigates the deleterious effects of ischemia/reperfusion injury to the recipient, and enables ex-situ treatment and repair to convert discarded to transplantable grafts. As such, it holds the promise to tackle organ shortage and revolutionize liver transplantation practices worldwide. Long-term perfusion recovered more than half of severely injury grafts in preclinical studies. This was successfully validated with the first in-human transplant after three-day preservation of a discarded graft. Successful pharmacological defatting of steatotic grafts within 7 days marked another milestone in organ perfusion. Next steps include the validation of long-term perfusion in a large-scale clinical trial (ongoing FDA trial) and continuation of breakthrough research leading to novel treatment strategies ex-situ.