pISSN 2671-8790 eISSN 2671-8804

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Korean J Transplant 2022; 36(1): 2-14

Published online March 31, 2022

https://doi.org/10.4285/kjt.22.0008

© The Korean Society for Transplantation

Cold but not too cold: advances in hypothermic and normothermic organ perfusion

Guenter Kirste

Department of Surgery, University Hospital of Freiburg, Albert Ludwig University of Freiburg, Freiburg im Breisgau, Germany

Correspondence to: Guenter Kirste
Department of Surgery, University Hospital of Freiburg, Albert Ludwig University of Freiburg, Hugstetter St., 55, Freiburg im Breisgau 79106, Germany
Tel: +49-170-5613312
Fax: +49-766-44037772
E-mail: gkirste@icloud.com

Received: February 15, 2022; Accepted: February 21, 2022

Abstract

Transplantation is the method of choice and, in many cases, the only method of treatment for patients with end-stage organ disease. Excellent results have been achieved, and the main focus today is to extend the number of available donors. The use of extended-criteria donors or donors after circulatory death is standard, but is accompanied by an increased risk of ischemia reperfusion injury. This review presents newly developed machine perfusion techniques using hypothermic, subnormothermic, or normothermic conditions, with or without oxygenation. Possibilities for treatment and quality assessment in decision-making about organ acceptability are also discussed.

Keywords: Organ donation, Organ protection, Cold storage, Normothermic machine perfusion, Ischemic reperfusion injury

HIGHLIGHTS
  • To establish good graft function Ischemia reperfusion injury (IRI) must be reduced as much as possible.

  • Normothermic machine perfusion (NMP) is currently the best method to avoid IRI.

  • NMP is specifically important in heart transplantation and is the standard procedure in DCD.

  • More sophisticated perfusion technique allows evaluation and even treatment of organs for transplantation.