machineperfusie

Machine perfusion, referred to as machineperfusie in Dutch, is a technique used in organ transplantation to preserve and assess donor organs by actively circulating a preservation solution through the organ with a programmable device. Unlike static cold storage, machine perfusion maintains continuous perfusion at a controlled temperature and pressure, often with oxygenation, to reduce cellular injury during transport and storage.

There are two main temperature regimes: hypothermic machine perfusion (HMP), typically around 4 to 10°C, and normothermic machine perfusion (NMP), near body temperature. Some protocols use subnormothermic temperatures. Organs are connected to the perfusion device after procurement; pumps regulate flow and pressure, while sensors monitor parameters such as resistance, temperature, and perfusate composition. In NMP, additional nutrients and oxygen support organ metabolism and may allow functional assessment, such as bile production in liver or urine output in kidney.

Benefits of machine perfusion include reduced ischemia-reperfusion injury, improved graft evaluation, potential extension of preservation time, and the possibility of reconditioning marginal organs. It can facilitate transport over longer distances and may increase the usable donor pool by enabling better assessment and optimization before transplantation.

Applications and evidence vary by organ. Machine perfusion is widely used for kidneys and increasingly employed for livers, hearts, and lungs. Clinical studies report lower rates of delayed graft function in kidney transplants and suggest improvements for other organs, though outcomes and cost-effectiveness continue to be evaluated in ongoing trials and analyses.

Challenges include equipment cost, complexity, need for trained staff, and standardization of protocols. Future directions focus on optimized perfusates, oxygenation strategies, viability assessment during perfusion, and broader adoption in organ procurement and allocation.