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World J Transplantation. Jan 16, 2019; 9(1): 14-20
Published online Jan 16, 2019. doi: 10.5500/wjt.v9.i1.14
Machine perfusion of the liver: Which is the best technique to mitigate ischaemia-reperfusion injury?
Yuri L Boteon, Simon C Afford
Yuri L Boteon, Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
Yuri L Boteon, Simon C Afford, Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
Yuri L Boteon, Simon C Afford, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom
Author contributions: Boteon YL designed this study and drafted the manuscript; Afford SC reviewed critically the manuscript; all authors contributed to editing and approved the final manuscript version.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Simon C Afford, FRCPA, PhD, Reader (Associate Professor), Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom. s.c.afford@bham.ac.uk
Telephone: +44-121-4158698
Received: November 3, 2018
Peer-review started: November 5, 2018
First decision: December 6, 2018
Revised: December 11, 2018
Accepted: January 5, 2019
Article in press: January 6, 2019
Published online: January 16, 2019
Core Tip

Core tip: Hepatic ischaemia-reperfusion injury (IRI) is the main culprit of post-transplantation graft dysfunction and ischaemic-type biliary lesions. Despite the increased demand, extended-criteria donor livers are more vulnerable to IRI, thereby presenting inferior postoperative outcomes. Hence, the mitigation of IRI should drive the setting of a new benchmark for extended-criteria donor organ preservation. Machine perfusion of the liver has the potential to mitigate IRI via a shortening of the ischaemic period of the livers or the reconditioning of their bioenergetic status. Interventions to further alleviate IRI, such as pharmacological or nonpharmacological metabolic modulation of donor organs, may amplify this effect.