Assist devices: machine preservation of extended criteria donors.

KEY POINTS: 1. Hypothermic machine perfusion (HMP) is in its infancy in clinical liver transplantation. Potential benefits include diminished preservation injury (PI) and improved graft function. 2. We have employed HMP in 21 extended criteria donor (ECD livers) at our center with excellent clinical outcomes. 3. Our experience with liver HMP is the only reported clinical experience worldwide representing a total of 41 successful liver transplant cases showing improved outcomes and diminished markers of ischemia/reperfusion injury. 4. Further multicenter and large scale trials are now warranted to further explore the benefits and applicability of liver HMP into the clinical mainstream.