In recent years, machine perfusion has gained attention as a promising alternative to cold storage during graft storage in transplantation, offering dynamic preservation by continuously perfusing organs to mimic physiological conditions. The primary perfusion modalities—hypothermic machine perfusion (HMP), subnormothermic machine perfusion (SNMP), and normothermic machine perfusion (NMP)—present opportunities to enhance preservation quality, minimize ischemic injury, and expand the donor organ pool by making marginal organs viable for transplantation. Despite these advancements, the choice of perfusion solution remains a critical factor that influences the success of organ preservation and transplantation outcomes. The composition and properties of perfusion solutions can impact cellular metabolism, tissue integrity, and overall organ function. Therefore, it is essential to explore and evaluate different perfusion solutions systematically to determine their efficacy across various perfusion modalities. Standardizing the use of the most suitable perfusion solutions could lead to improved organ viability, better transplantation outcomes, and increased availability of donor organs. The PubMed database was searched for articles using word combinations, concerning liver, kidney and pancreas machine perfusion. Primarily, the studies comparing various perfusion solutions and their modifications were included in the results and summed up shortly in a table for easier overview. Additionally, relevant articles about experimental and clinical use of certain perfusion solutions, including their use in RCTs, were included as well. A total of 53 articles, where a direct comparison of perfusion solutions and its modifications were found. A total of 25 studies focused on hypothermic machine perfusion (HMP). 4 studies addressed subnormothermic machine perfusion (SNMP). 20 studies compared perfusion solutions during normothermic machine perfusion (NMP). 4 studies addressed rewarming procedures. 7 studies examined perfusion solutions on human grafts in experimental or clinical transplantation settings. No studies were found comparing perfusion solutions during pancreas MP. Relevant clinical trials and RCTs were also included. For hypothermic machine perfusion (HMP), Belzer Machine Perfusion Solution (MPS) remains the most widely utilized in both clinical applications and randomized controlled trials (RCTs). Its widespread adoption underscores its reliability and effectiveness in preserving organ viability. However, other perfusion solutions also show promise and could serve as viable alternatives. These include HTK (Custodiol), IGL-2, Celsior and Vasosol, as well as other less- explored promising options, as described in the results section. The encouraging results from these alternatives suggest that more comparative studies are needed to assess their efficacy relative to Belzer MPS and each other. In subnormothermic machine perfusion (SNMP), the inclusion of an oxygen carrier appears to be beneficial in maintaining organ metabolism and viability. Although research is more limited in this area, for exmaple, such solutions as Celsior and Lifor without an oxygen-carrier addition have also been tested. However, the variability in results highlights the need for further investigation to optimize the composition of perfusion solutions for SNMP and confirm their potential advantages. Normothermic machine perfusion (NMP) has shown that the use of an oxygen carrier is crucial to mimic physiological conditions and support cellular respiration. Red blood cells (RBCs) are the most frequently used oxygen carriers in clinical settings, offering effective oxygenation of organs. However, Hemopure, an oxygen-carrying substitute, has demonstrated promising results, suggesting that it could serve as an alternative to RBCs, particularly in situations where blood products are unavailable or undesirable. Other alternative oxygen carriers also show potential, and their role in NMP warrants further exploration to determine the best formulations for preserving different types of abdominal organs. As for the medium used in combination with the oxygen carrier, there is also not a clear favorite found yet, with various options being utilized and studied. Overall, this review highlights the need for more standardized research efforts, including well- designed RCTs, to directly compare the effectiveness of different perfusion solutions, as well as their logistic and economic advantages. Such studies should not only compare newer solutions against standard options like Belzer MPS and RBC-based perfusates but also evaluate promising alternatives against each other. By doing so, it will be possible to identify the most effective perfusion solutions for different machine perfusion modalities, ultimately improving organ preservation, transplantation outcomes, and expanding the donor organ pool.
| Datum der Bewilligung | 2025 |
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| Originalsprache | Englisch |
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| Gradverleihende Hochschule | - Medizinische Universität Graz
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| Betreuer/-in | Philipp Stiegler (Betreuer*in) & Bettina Leber (Mitbetreuer*in) |
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