Preservation of the liver for transplantation: Machine perfusion-based strategies for extended preservation and recovery

The field of liver transplantation remains burdened by a severe shortage of donor organs. An important limitation to the use of many livers is the ex vivo preservation of the organ, as maintaining the viability of the donor organ while outside the body is essential for successful transplantation. This thesis introduces novel and innovative strategies for the preservation of the liver for transplantation aimed at extending liver preservation time as well as recovery of injured liver grafts. These preservation strategies were applied in a series of both pre-clinical and human liver studies. A new supercooling technique, using subzero preservation in conjunction with machine perfusion is introduced and shown to substantially lengthen the viable preservation time of the liver. Moreover, we demonstrate that machine perfusion-based preservation modalities are superior to static hypothermic preservation, and have the potential to recover untransplantable, ischemic livers.