Machine Perfusion Liver Preservation: Highlights From the International Liver Transplant Society 2024.

The 2024 International Liver Transplantation Society (ILTS) Congress, held in Houston, Texas, brought together a dynamic, multidisciplinary community of global experts to explore and discuss cutting-edge innovations and unmet needs in liver transplantation. Key themes included liver machine perfusion and donation after circulatory death (DCD), reflecting the ongoing effort to expand the donor pool and improve transplantation outcomes. Machine perfusion technologies, including normothermic machine perfusion (NMP), hypothermic oxygenated perfusion (HOPE), and normothermic regional perfusion (NRP) have demonstrated great promise in optimizing graft quality, mitigating ischemia-reperfusion injury, and enhancing the use of marginal and DCD liver grafts. At this year's congress a total of 63 abstracts on liver machine perfusion were presented. For this report we selected all orally presented abstracts highlighting advances in organ preservation, artificial intelligence, treatments during ex-situ perfusion including cellular therapy as well as new the use of new biomarkers. Preclinical highlights included the potential of long-term NMP to sustain and regenerate grafts during extended ex-situ preservation, spontaneous defatting of steatotic grafts during LT-NMP, the delivery of regulatory T cells to enable organ-level immunomodulation and the removal of damage-associated molecular patterns from porcine DCD livers during NMP. On the clinical side, key points included the progression of HOPE to IDEAL-D Stage 4 evidence, increased transplant volumes through the application of NMP, the cost-effectiveness of NMP as well as the utilization of very old DCD donors through NRP. Collectively, these advancements mark a transition toward dynamic, data-driven, and personalized transplantation strategies. Machine perfusion remains central to optimizing grafts, expanding the pool of organs suitable for transplantation enhancing access to liver transplantation and improving outcomes for liver transplant recipients worldwide.