Table 1.
Viability criteria used in the clinical practice
| Reference | Number of livers | DCD/DBD | Viability criteria | Outcomes |
| HMP | ||||
| Eden et al.[16] (2023) | Perfused: not specified Transplanted: 158 |
Not specified | FMN at 30 min of HOPE (<6000 A.U.) NADH at 30 min of HOPE (<8.000 A.U.) |
89% 1-year graft survival 7 PNF 11 IC 53 AS 9 bile leakage |
| Patrono et al.[17] (2020) | Perfused: 50 Transplanted: 50 |
0/50 | Perfusate lactate, AST, ALT, LDH, glucose, and pH during DHOPE | 1 graft loss 13 EAD |
| Schlegel et al.[15] (2020) | Perfused: 50 Transplanted: 50 |
32/18 | Perfusate, tissue and mitochondria during HOPE: FMN at 30 min (<8000 A.U.) NADH (<10 000 A.U.) |
7 graft loss (unspecified) |
| Muller et al.[14] (2019) | Perfused: 54 Transplanted: 54 |
35/19 | FMN within 30 min of HOPE | 7 graft loss 4 PNF 1 IC |
| NMP | ||||
| Van Leeuwen et al.[33] (2022) | Perfused: 54 Transplanted: 34 |
53/1 | After 2.5 h of NMP - Lactate <1.7 mmol/l - Perfusate pH 7.35–7.45 - Bile production >10 ml, of which ≥4 ml in the last hour - Bile pH > 7.45 - Delta pH bile and perfusate >0.10 - Delta sodium bicarbonate bile and perfusate >5.0 - Delta glucose bile and perfusate <−5.0 |
94% 1-year graft survival 1 NAS 12 AS 4 bile leakage |
| Seidita et al.[31] (2022) | Perfused: 19 Transplanted: 17 |
3/16 | - Lactate clearance normalization or at least halving of lactates at end of perfusion - pH > 7.3 - Bile production - Vascular flow HA and PV |
94% 1-year graft survival 1 EAD |
| Quintini et al.[29] (2022) | Perfused: 21 Transplanted: 15 |
13/8 | Within 6 h of NMP, ≥2 of the following - Perfusate lactate <4.5 mmol/l or decrease of 60% from peak in first 4 h - Bile production >2 mL/h - Stable HA and PV flow (>0.05 ml/min/g and >0.4 ml/min/g) - Macroscopic homogenous perfusion and soft consistency |
7 EAD 1 IC |
| Zhang et al.[36] (2020) | Perfused: 4 Transplanted: 4 Retrospect |
3/1 | Within 4 h of NMP - Perfusate lactate <2.5 mmol/l - Bile production - Stable HA and PV flow (>150 ml/min and >500 ml/min) - Perfusate pH > 7.3 |
100% 6-months graft survival 1 EAD 1 AS |
| Reiling et al.[30] (2020) | Perfused: 10 Transplanted: 10 |
5/5 | After 4 h of NMP - Perfusate lactate <2 mmol/l within 2 h - Metabolism of glucose, evidenced by decreasing trend by 4 h - Physiological pH without continuous need for sodium bicarbonate - Stable HA and PV flows - Homogenous graft perfusion with soft parenchyma consistency - Bile production (no lower limit) |
100% 6-months graft survival 5 EAD 1 AS 1 anastomotic leak |
| Mergental et al.[25] (2020) | Perfused: 31 Transplanted: 22 |
14/17 | Within 4 h of NMP - Perfusate lactate ≤2.5 mmol/l And ≥2 of the following criteria - Evidence of bile production - Perfusate pH ≥7.30 - Metabolism of glucose - Stable HA and PV flows (≥150 ml/min and ≥500 ml/min) - Homogenous perfusion with soft consistency of the parenchyma |
86.4% 1-year graft survival 7 EAD 4 NAS 2 AS |
| Cardini et al.[22] (2020) | Perfused: 34 Transplanted: 25 |
4/30 | After 2 h of NMP - Rapid decrease and maintenance of lactate levels (first 2 h of NMP) - Bile output and biliary pH - Maintaining a physiological perfusate pH without sodium bicarbonate - Warning signals: exceptionally high or sharp incline of AST, ALT and LDH |
88% graft survival at 20 months 7 AS 3 bile leakage |
| Bral et al.[21] (2019) | Perfused: 46 Transplanted: 43 |
10/33 | - Lactate level at start perfusion - Lactate clearance - Necessity of bicarbonate pH correction - Bile production |
100% 3-month graft survival 11 EAD 2 NAS 6 AS |
| Watson et al.[35] (2018) | Perfused: 47 Transplanted: 22 |
35/12 | - Peak lactate fall ≥4.4 mmol/l/kg/h - ALT <600 iU/l at 2 h - Perfusate pH > 7.2 with ≤30 mmol/l bicarbonate supplementation - Maximum bile pH > 7.5 - Bile glucose concentration ≤3 mmol/l or ≥10 mmol less than perfusate glucose - Falling glucose beyond 2 h or perfusate glucose under 10 mmol/l with subsequent fall during challenge with 2.5 g glucose |
1 PNF 1 EAD 4 IC |
ALT, alanine transaminase; AS, anastomotic biliary strictures; AST, aspartate aminotransferase; DBD, donation after brain death; DCD, donation after circulatory death; DHOPE, dual hypothermic oxygenated machine perfusion; EAD, early allograft dysfunction; HA, hepatic artery; HMP, hypothermic machine perfusion; HOPE, hypothermic oxygenated machine perfusion; IC, ischemic cholangiopathy; LDH, lactate dehydrogenase; NADH, nicotine adenine dinucleotide reduced; NAS, nonanastomotic biliary strictures; NMP, normothermic machine perfusion; PNF, primary nonfunction; PV, portal vein.