Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.314
Peer-review started: July 19, 2015
First decision: September 17, 2015
Revised: December 24, 2015
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: June 24, 2016
Processing time: 340 Days and 12.7 Hours
There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft’s for transplantation, improve the outcomes, and decrease the mortality on the waiting list.
Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.