Verma Sapana, George Maria Baimas, Mazariegos George, Vrochides Dionisios, Schlegel Andrea
Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Pediatr Transplant. 2025 Nov;29(7):e70202. doi: 10.1111/petr.70202.
Pediatric liver transplantation (PLT) is the only lifesaving procedure for children with advanced liver disease and tumors. Despite significant progress and overall success in PLT, the field continues to face challenges due to procedural complexity across a heterogeneous age group, especially in infants and small children. Despite the use of living donor grafts, waitlist mortality remains disproportionately high in these younger patients. The unique challenges in PLT-including limited donor availability and higher risk of complications-underscore the need for improved strategies to evaluate and optimize donor liver quality before implantation. Machine perfusion has emerged as a promising tool in this context. While the benefits of hypothermic oxygenated perfusion (HOPE) for whole and partial livers have been reported with applications during and after liver split, the evidence for normothermic machine perfusion (NMP) remains scarce. Since the first report in 2019, multiple case series and clinical studies support the efficacy of HOPE in reducing early graft dysfunction, biliary complications, and graft loss after liver transplantation in children. Despite this progress, there is a pressing need for coordinated research efforts to study how HOPE and NMP affect transplant outcomes in pediatric recipients, especially when expanding split criteria or using DCD grafts, which are vital for expanding the donor pool despite the known higher risk.
小儿肝移植（PLT）是患有晚期肝病和肿瘤的儿童唯一的救命手术。尽管小儿肝移植取得了显著进展并总体成功，但由于不同年龄组手术的复杂性，该领域仍面临挑战，尤其是在婴儿和幼儿中。尽管使用了活体供肝，但在这些较年轻的患者中，等待名单上的死亡率仍然过高。小儿肝移植中的独特挑战——包括供体可用性有限和并发症风险较高——凸显了在植入前评估和优化供肝质量的改进策略的必要性。在这种情况下，机器灌注已成为一种有前景的工具。虽然低温氧合灌注（HOPE）对全肝和部分肝的益处已在肝分割期间和之后的应用中得到报道，但常温机器灌注（NMP）的证据仍然很少。自2019年首次报告以来，多个病例系列和临床研究支持HOPE在降低儿童肝移植后早期移植物功能障碍、胆道并发症和移植物丢失方面的疗效。尽管取得了这一进展，但迫切需要开展协调一致的研究工作，以研究HOPE和NMP如何影响小儿受者的移植结果，特别是在扩大分割标准或使用DCD移植物时，尽管已知风险较高，但这对于扩大供体库至关重要。
