Background and rationale {6a}
fits, I/R) injury, Ischemia
COLD, HEPATOCELLULAR DAMAGE, ISCHEMIA
Ischemia–reperfusion (I/R) injury is universal in organ transplantation and results in microcirculatory and hepatocellular damage [Given the scarce donor supply, an increasing number of so-called marginal or extended criteria donor (ECD) organs are used for liver transplantation, grafts which were previously rarely considered [Considering the excellent results achieved with machine perfusion preservation in kidney transplantation from ECD donors, machine perfusion techniques have been developed for liver grafts during the past decade and have shown promising results by decreasing reperfusion injury. Two major techniques for liver machine perfusion have been developed: normothermic or hypothermic oxygenated perfusion [In contrast, the end-ischemic hypothermic oxygenated perfusion (HOPE) technique, which consists of using the machine perfusion procedure only during the last hours prior to transplantation, can be easily applied in the operating room where the transplant takes place, without any deviation from the usual organ transport and preparation methods used in the static cold storage procedure. Usually, during recipient hepatectomy, an interval of 1 to 3 h accumulates before the graft can be implanted. This period fits with the concept of a short-term hypothermic machine perfusion, applied after back-table preparation without delaying the transplant procedure. HOPE has been extensively tested in preclinical animal experimentations [Despite the fact that liver machine perfusion is a promising method in liver transplantation, it has not spread into clinical practice as few results from randomized controlled trials (RCT) are currently available [The HOPE technique appears to be simple and safe to perform because it is applied only a few hours before graft implantation in the transplantation center following usual transportation in static cold storage. Its feasibility and diffusion to teams are therefore easier.