Current Landscape of Experimental and Clinical Normothermic Regional Perfusion and Ex-situ Liver Machine Perfusion Protocols

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Guest Editors

Renato Romagnoli

University of Torino

Renato Romagnoli is an Associate Professor of Surgery at the University of Torino. He obtained a European medical qualification in Medicine and a specialization in General Surgery at the University of Turin in 1990 and 1995, respectively. His interests range from liver and pancreas transplantation, organ preservation, and translational applications of regenerative medicine to organ transplantation, to hepato-biliary-pancreatic surgery, esophageal and gastric surgery, and foregut motility. He has performed or supervised over 5,000 major HPB or digestive surgery procedures, authored more than 180 peer-reviewed articles, and is an Editorial Board member of “Scientific Reports” and “Digestive and Liver Disease.” Since 2009, he has been a member of the European Board of Surgery. In 2018, he was appointed as Director of the General Surgery 2U – Liver Transplant Unit at the Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.

Damiano Patrono

Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126, Turin (Italy), General Surgery 2U – Liver Transplant Unit

Damiano Patrono (1978) is an attending surgeon at the General Surgery 2U – Liver Transplant Center, AOU Città Della Salute e Della Scienza di Torino (Turin, Italy), with interest in liver and pancreas transplantation, liver preservation, and minimally invasive HPS surgery. He obtained his medical qualification in 2003 and completed his residency in General Surgery in 2009 at the University of Turin. He also trained in Nice (France), Brussels (Belgium), and Oxford (United Kingdom). In 2015, he obtained his PhD in technologies applied to surgical sciences at the University of Turin. As a technology enthusiast, he is a convinced promoter of machine perfusion and other dynamic preservation techniques in liver transplantation.

Nicola De Stefano

Liver Transplant Unit, Turin

Dr. Nicola De Stefano is a General Surgery Resident at the Liver Transplant Unit in Turin. During his medical degree, he attended the MD-PhD program at the University of Turin under the supervision of Prof. Renato Romagnoli. His research and peer-review activity focus on liver transplantation, machine perfusion technology, and stem cell-based therapies for organ regeneration, with a particular interest in extracellular vesicles and liver graft reconditioning. He was recently awarded the “Leonardo Da Vinci Transplant Research Innovation Award” at the European Society for Organ Transplantation Congress (Milan, 2022).

Collection Overview

Normothermic regional perfusion (NRP) and ex-situ liver machine perfusion (MP) are transforming the field of liver procurement, preservation, and transplantation. These techniques allow for the reduction of ischemia-reperfusion injury, the extension of preservation time, and the testing of liver viability prior to transplantation, resulting in a higher utilization rate and better outcomes for liver transplantation. Furthermore, their introduction has opened the door for treatments aimed at repairing or reconditioning damaged grafts, improving their function after transplantation. These treatments include liver defatting, reconditioning by stem cells and derived products, treatment of donor infection, cytokine filtering, and repair by organoid administration, which have been explored in the experimental setting but are still not implemented in clinical practice.

The experimental and clinical NRP and MP protocols used today vary greatly between countries, centers, and research groups. There are significant differences in indications, operational procedures, devices, settings, timing, and other technical details. These disparities make it difficult to compare results from different studies and create some uncertainty for those groups willing to use these techniques in both experimental and clinical settings. Sharing practical and technical aspects of various NRP and MP protocols would aid in clinical implementation and establishing experimental models in laboratory research. By providing detailed examples of clinical and experimental NRP and MP protocols and models, this Methods Collection aims to promote the widespread adoption of these techniques in clinical practice and further research in this exciting field.