Extended preservation and viability assessment of the liver for transplantation

Liver transplantation is the only cure for patients with end-stage liver failure, however its success is seriously curtailed by the shortage of suitable donor livers. Restrictions in organ preservation substantially limit the pool of usable donor livers. The long-term goal of this thesis is to reduce deaths due to the organ shortage and improve outcomes after liver transplantation by developing improved organ preservation methods that can extend the preservation duration and advance viability assessment of liver grafts. This thesis presents novel strategies for subzero organ preservation and innovative methods to assess liver viability during machine perfusion. These were developed and tested in various pre-clinical animal and human liver studies. Results of these studies showed that subzero preservation strategies can extend the preservation duration and new methods to assess liver viability hold great promise to increase the number of donor livers that can be transplanted. The findings of this thesis justify translation of these innovations to the clinic to help reduce deaths due to the shortage of donor livers for transplantation.