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Ex situ 86‐hour liver perfusion: Pushing the boundary of organ preservation

For almost 3 decades, cold storage (CS) has been the standard method used to preserve liver grafts prior to transplantation. However, marginal grafts are susceptible to cold ischemia, making CS a suboptimal preservation modality for these organs. The transplant community has recently become increasingly interested in the application of normothermic machine perfusion (NMP), an innovative preservation technique. NMP maintains the liver graft’s metabolism by continuously supplying oxygen and nutrients at physiologic temperature. Studies indicate that NMP can restore energy content, hepatobiliary function, and microcirculation, thus improving liver quality prior to transplantation. More importantly, NMP holds the potential to increase the duration of organ preservation, which can minimize logistical limitations of CS, recondition injured organs, and manipulate the graft to improve transplant outcomes. As of today, the longest recorded maintenance of active liver metabolism of human organs outside of the body is 24 hours and 72 hours in a porcine model. Herein, we report a case describing the metabolic activity of a discarded human liver during 86 hours of ex situ NMP.