Where are we today with machine perfusion of liver in donation after circulatory death liver transplantation?

Livers procured from donors after circulatory death (DCD) have increasingly been used for liver transplantation (LT) to address the organ crisis. While DCD LT increases patient access to life-saving treatment, this practice creates risks for recipients, including primary allograft non-function, early allograft dysfunction, and ischemic cholangiopathy. These complications are due to the unique ischemia and reperfusion injury related to different phases of organ procurement and preservation in DCD. Therefore, substantial research efforts and innovations on DCD LT have primarily aimed at reducing these complications. One such advance is the utilization of ex vivo machine perfusion of the donor liver in DCD LT. This review focused on the data from clinical trials and studies in human DCD LT.