Machine perfusion of pediatric and technical variant liver grafts.

Purpose of review: Liver transplantation using pediatric and technical variant grafts presents unique challenges due to graft size, vascular anomalies, and ischemia-reperfusion injury. Static cold storage has been the standard preservation method, but machine perfusion is emerging as a superior technique for improving graft function and posttransplant outcomes. This review addresses the role of machine perfusion in preserving pediatric and technical variant grafts with a focus on feasibility and impact on graft viability and early allograft function.

Recent findings: Clinical and experimental studies of hypothermic and normothermic machine perfusion were reviewed for pediatric and technical variant grafts. Key parameters, perfusion dynamics, biochemical markers, and outcomes were investigated and suggested that machine perfusion enhances graft quality. In addition, the feasibility and potential of liver splitting during machine perfusion along with technical considerations is being addressed.

Summary: Machine perfusion represents a transformative approach for pediatric and technical variant grafts, improving preservation quality and posttransplant outcomes while minimizing adverse events especially primary graft nonfunction. Currently, only normothermic machine perfusion enables viability assessment, offering a potential for expanding the donor pool. Due to the low number of pediatric liver transplantation and utilization of technical variant grafts, multicenter studies are required to define protocols and selection criteria for individual grafts, and establish machine perfusion as a standard practice in pediatric liver transplantation.