A review of 203 human livers perfused with NMP, including 154 transplants, revealed that despite well-established viability criteria, 11% of transplanted livers still developed non-anastomotic biliary strictures. The study underscores the variability in biomarker thresholds across centers, with factors such as bile production, pH, glucose absorption, and lactate metabolism playing critical but sometimes inconsistent roles in graft assessment. The need for reliable markers of mitochondrial function, such as flavin mononucleotide (FMN), is emphasized as a means to enhance liver viability assessment. The study calls for larger registry data and multicenter validation to refine predictive models and ensure reliable transplant decision-making.
Schlegel A. Machine Perfusion as “Comfort Zone”: What Are Key Challenges of Liver Viability Assessment Today?. Transplantation. 2022;106(12):2295-2298. doi:10.1097/TP.0000000000004264
