Machine perfusion of the liver and bioengineering

Andrea Schlegel, Hynek Mergental, Constantino Fondevila, Robert J. Porte, Peter J. Friend, Philipp Dutkowski*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

12 Citations (Scopus)
67 Downloads (Pure)


With the increasing number of accepted candidates on waiting lists worldwide, there is an urgent need to expand the number and the quality of donor livers. Dynamic preservation approaches have demonstrated various benefits, including improving liver function and graft survival, and reducing liver injury and post-transplant complications. Consequently, organ perfusion techniques are being used in clinical practice in many countries. Despite this success, a proportion of livers do not meet current viability tests required for transplantation, even with the use of modern perfusion techniques. Therefore, devices are needed to further optimise machine liver perfusion – one promising option is to prolong machine liver perfusion for several days, with ex situ treatment of perfused livers. For example, stem cells, senolytics, or molecules targeting mitochondria or downstream signalling can be administered during long-term liver perfusion to modulate repair mechanisms and regeneration. Besides, today's perfusion equipment is also designed to enable the use of various liver bioengineering techniques, to develop scaffolds or for their re-cellularisation. Cells or entire livers can also undergo gene modulation to modify animal livers for xenotransplantation, to directly treat injured organs or to repopulate such scaffolds with “repaired” autologous cells. This review first discusses current strategies to improve the quality of donor livers, and secondly reports on bioengineering techniques to design optimised organs during machine perfusion. Current practice, as well as the benefits and challenges associated with these different perfusion strategies are discussed.

Original languageEnglish
Pages (from-to)1181-1198
Number of pages18
JournalJournal of Hepatology
Issue number6
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
PD and AS are generally supported by the Swiss National Science Foundation with the following grants: 33IC30_166909 , 320030_189055/1 .

Publisher Copyright: © 2023 The Author(s)


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