Normothermic machine preservation as an approach to decrease biliary complications of DCD liver grafts

Abstract

Because of frequent biliary complications, it is crucial to develop new strategies to improve the quality of donors after cardiac death (DCD) liver grafts. I read with interest the article by Boehnert et al . The rate and severity of biliary epithelium damage they have reported after 60 min of warm ischemia and an additional 4–12 h of cold is extremely low compared to what has been published before and overestimates in large scale the potential benefit that machine perfusion can provide. They showed that despite this massive ischemic insult, four out of five DCD grafts on machine preservation had no detectable injury, with intact mucosa lining of the bile duct at the end of blood reperfusion, while the control group had 100% necrosis.