Figure 1.

Survival of liver grafts after transplantation in-situ and ex-situ under the best possible normothermic conditions on different devices. Despite recent improvements of machine perfusion technology, liver graft survival during ex-situ perfusion remains limited and strongly depends on the perfusion device and the creation of a near physiological environment. Sophisticated and automatic devices, which include centrifugal pumps, oxygenators with a prolonged capability, dialysis, nutrition and diaphragm simulation may potentially prolong ex-situ survival of healthy livers for up to several day or weeks. Importantly, all devices fail to prevent the initiation of reperfusion injury and also the clearance, which lead therefore to an ongoing inflammation during prolonged perfusion of injured or high-risk liver grafts.