Machine perfusion in liver transplantation as a tool to prevent non-anastomotic biliary strictures: Rationale, current evidence and future directions

Pepijn D. Weeder, Rianne van Rijn, Robert J. Porte*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

48 Citations (Scopus)

Abstract

The high incidence of non-anastomotic biliary strictures (NAS) after transplantation of livers from extended criteria donors is currently a major barrier to widespread use of these organs. This review provides an update on the most recent advances in the understanding of the etiology of NAS. These new insights give reason to believe that machine perfusion can reduce the incidence of NAS after transplantation by providing more protective effects on the biliary tree during preservation of the donor liver. An overview is presented regarding the different endpoints that have been used for assessment of biliary injury and function before and after transplantation, emphasizing on methods used during machine perfusion. The wide spectrum of different approaches to machine perfusion is discussed, including the many different combinations of techniques, temperatures and perfusates at varying time points. In addition, the current understanding of the effect of machine perfusion in relation to biliary injury is reviewed. Finally, we explore directions for future research such as the application of (pharmacological) strategies during machine perfusion to further improve preservation. We stress the great potential of machine perfusion to possibly expand the donor pool by reducing the incidence of NAS in extended criteria organs. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)265-275
Number of pages11
JournalJournal of Hepatology
Volume63
Issue number1
DOIs
Publication statusPublished - Jul-2015

Keywords

  • Liver transplantation
  • Bile Duct Diseases/etiology
  • Bile Duct Diseases/prevention & control
  • Bile Ducts/blood supply
  • Bile Ducts/injuries
  • Bile Ducts/surgery
  • Ischemia/prevention & control
  • Liver Transplantation/adverse effects
  • Reperfusion Injury/prevention & control
  • Machine perfusion
  • BILE-DUCT INJURY
  • MESENCHYMAL STEM-CELLS
  • NORMOTHERMIC EXTRACORPOREAL PERFUSION
  • MULTIPOTENT STEM/PROGENITOR CELLS
  • TRYPTOPHAN-KETOGLUTARATE SOLUTION
  • CONTROLLED NONHEARTBEATING DONORS
  • ISCHEMIA-REPERFUSION INJURY
  • OF-WISCONSIN SOLUTION
  • CARDIAC DEATH DONORS
  • ORGAN-PRESERVATION

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