M. Thamara P. R. Perera

TL;DR: Normothermic machine perfusion of the liver improved early graft function, demonstrated by reduced peak serum aspartate transaminase levels and early allograft dysfunction rates, and improved organ utilization and preservation times, although no differences were seen in graft or patient survival.

TL;DR: 5-year graft survival in donation after cardiac death livers treated by conventional cold storage, or by 1-2 h of hypothermic oxygenated perfusion (HOPE) after cold storage suggests that a simple end-ischaemic perfusion approach is very effective and may open the field for safe utilisation of extended DCD liver grafts.

TL;DR: The VITTAL clinical trial as discussed by the authors used normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria, which enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent nonanastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.

TL;DR: The early diagnosis of hepatic artery thrombosis (HAT) decreases septic complications, multiorgan failure, and graft loss, and there are better outcomes after treatment as discussed by the authors.

TL;DR: NMP allows an objective assessment of liver function that may reduce the risk and permit use of currently unused high‐risk livers, and proposes composite viability criteria consisting of lactate clearance, pH maintenance, bile production, vascular flow patterns, and liver macroscopic appearance.