《Table 1 Advantages and disadvantages of different modalities of machine perfusion of the liver》

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《Machine perfusion of the liver: Which is the best technique to mitigate ischaemia-reperfusion injury》

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Donor organs with steatosis，organs that have been exposed to prolonged preservation times，organs from elderly donors，or organs from donation after circulatory death（DCD）are all more vulnerable to IRI and therefore are referred to as marginal or extended criteria donor（ECD）organs[7].The defining parameters of ECD organs can vary slightly amongst centres[8]，although，consistently，ECD-LT is associated with high rates of graft dysfunction and lower patient and graft survival posttransplantation[9-11].Despite inferior outcomes，the utilisation of ECD livers is required to tackle the shortfall of donor organs for transplantation.Whilst transplant surgeons do not have control over these donor features，they can consider alternatives to better preserve or even recondition ECD livers.The wider utilisation of ECD livers has exceeded the preservation capacities of traditional static cold storage（SCS），and machine perfusion（MP）of the liver is considered to be a possible alternative preservation method.The use of this technique may offer several advantages in comparison with SCS，including superior organ preservation，limiting ischaemia；the assessment of organ function prior to transplantation；and the possibility of improving or repairing highly vulnerable organs[12].Nevertheless，benefits may vary between different modalities of MP（Table 1）；therefore，those protocols are frequently seen as divergent or even competitive at this time.Herein，the advantages and limitations of each individual technique in relation to the possibility of IRI mitigation are briefly discussed in an attempt to identify which is the best technique of MP of the liver.