Abstract：
OBJECTIVE: Machine perfusion has been adopted into clinical practice in Europe since the mid-2010s and, more recently, in the United States (US) following approval of normothermic machine perfusion (NMP). We aim to review recent advances, provide discussion of potential future directions, and summarize challenges currently facing the field.
RESULTS: Both NMP and hypothermic-oxygenated perfusion (HOPE) improve overall outcomes after liver transplantation versus traditional static cold storage (SCS) and offer improved logistical flexibility. HOPE offers additional protection to the biliary system stemming from its\' protection of mitochondria and lessening of ischemia-reperfusion injury. Normothermic regional perfusion (NRP) is touted to offer similar protective effects on the biliary system, though this has not been studied prospectively.The most critical question remaining is the optimal use cases for each of the three techniques (NMP, HOPE, and NRP), particularly as HOPE and NRP become more available in the US. There are additional questions regarding the most effective criteria for viability assessment and the true economic impact of these techniques. Finally, with each technique purported to allow well tolerated use of riskier grafts, there is an urgent need to define terminology for graft risk, as baseline population differences make comparison of current data challenging.
CONCLUSIONS: Machine perfusion is now widely available in all western countries and has become an essential tool in liver transplantation. Identification of the ideal technique for each graft, optimization of viability assessment, cost-effectiveness analyses, and proper definition of graft risk are the next steps to maximizing the utility of these powerful tools.
RESULTS: Both NMP and hypothermic-oxygenated perfusion (HOPE) improve overall outcomes after liver transplantation versus traditional static cold storage (SCS) and offer improved logistical flexibility. HOPE offers additional protection to the biliary system stemming from its\' protection of mitochondria and lessening of ischemia-reperfusion injury. Normothermic regional perfusion (NRP) is touted to offer similar protective effects on the biliary system, though this has not been studied prospectively.The most critical question remaining is the optimal use cases for each of the three techniques (NMP, HOPE, and NRP), particularly as HOPE and NRP become more available in the US. There are additional questions regarding the most effective criteria for viability assessment and the true economic impact of these techniques. Finally, with each technique purported to allow well tolerated use of riskier grafts, there is an urgent need to define terminology for graft risk, as baseline population differences make comparison of current data challenging.
CONCLUSIONS: Machine perfusion is now widely available in all western countries and has become an essential tool in liver transplantation. Identification of the ideal technique for each graft, optimization of viability assessment, cost-effectiveness analyses, and proper definition of graft risk are the next steps to maximizing the utility of these powerful tools.
摘要：
目的：自2010年代中期以来，机器灌注已在欧洲的临床实践中采用，最近,在美国（US）批准正常体温机灌注（NMP）后。我们的目标是回顾最近的进展，提供潜在未来方向的讨论，并总结了该领域目前面临的挑战。
结果：与传统静态冷藏（SCS）相比，NMP和低温氧合灌注（HOPE）均可改善肝移植后的总体结局，并提供改善的后勤灵活性。HOPE通过保护线粒体和减轻缺血再灌注损伤为胆道系统提供了额外的保护。正常体温区域灌注（NRP）被吹捧为对胆道系统提供类似的保护作用，尽管尚未进行前瞻性研究。剩下的最关键的问题是三种技术(NMP，希望,和NRP），特别是随着希望和NRP在美国变得越来越可用。关于可行性评估的最有效标准和这些技术的真正经济影响，还有其他问题。最后,每种技术都被认为可以很好地耐受使用风险较高的移植物，迫切需要定义嫁接风险的术语，由于基线人群的差异使得当前数据的比较具有挑战性。
结论：机器灌注现在在所有西方国家广泛使用，并已成为肝移植的重要工具。确定每种移植物的理想技术，生存能力评估的优化，成本效益分析，和正确定义的嫁接风险是下一步，以最大限度地利用这些强大的工具。
结果：与传统静态冷藏（SCS）相比，NMP和低温氧合灌注（HOPE）均可改善肝移植后的总体结局，并提供改善的后勤灵活性。HOPE通过保护线粒体和减轻缺血再灌注损伤为胆道系统提供了额外的保护。正常体温区域灌注（NRP）被吹捧为对胆道系统提供类似的保护作用，尽管尚未进行前瞻性研究。剩下的最关键的问题是三种技术(NMP，希望,和NRP），特别是随着希望和NRP在美国变得越来越可用。关于可行性评估的最有效标准和这些技术的真正经济影响，还有其他问题。最后,每种技术都被认为可以很好地耐受使用风险较高的移植物，迫切需要定义嫁接风险的术语，由于基线人群的差异使得当前数据的比较具有挑战性。
结论：机器灌注现在在所有西方国家广泛使用，并已成为肝移植的重要工具。确定每种移植物的理想技术，生存能力评估的优化，成本效益分析，和正确定义的嫁接风险是下一步，以最大限度地利用这些强大的工具。
