Machine perfusion of donor organs for transplantation

다국어 초록 (Multilingual Abstract)

The ever‐widening gap between organ supply and demand has resulted in an organ shortage crisis that affects patients all over the world. For decades, static cold storage (SCS) was the gold standard preservation strategy because of its simplicity and cost‐effectiveness, but the rising unmet demand for donor organ transplants has prompted investigation into preservation strategies that can expand the available donor pool. Through ex vivo functional assessment of the organ prior to transplant, newer methods to preserve organs such as perfusion‐based therapy can potentially expand the available organ pool. This review will explain the physiologic rationale for SCS before exploring the advantages and disadvantages associated with the two broad classes of preservation strategies that have emerged to address the crisis: hypothermic and normothermic machine perfusion. A detailed analysis of how each preservation strategy works will be provided before investigating the current status of clinical data for each preservation strategy for the kidney, liver, pancreas, heart, and lung. For some organs there is robust data to support the use of machine perfusion technologies over SCS, and in others the data are less clear. Nonetheless, machine perfusion technologies represent an exciting frontier in organ preservation research and will remain a crucial component of closing the gap between organ supply and recipient demand.
Addressing the present organ shortage crisis requires an exploration of innovative strategies to preserve and assess organs prior to transplantation. Machine perfusion is an exciting preservation option that has the possibility to expand the available donor pool and recover marginal donor organs. Although the available clinical data provides a mixed picture, depending on the type of organ and device being used, machine perfusion will remain an important tool moving forward to close the gap between organ supply and demand.