{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:28:14Z","timestamp":1788791294656,"version":"build-2803163510"},"reference-count":107,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:p>Organ transplantation remains the definitive treatment for end-stage organ failure, yet its impact continues to be constrained by a persistent shortage of suitable donor organs. Despite advances in surgical technique, immunosuppression, and recipient management, organ preservation has remained relatively unchanged for decades. Machine perfusion (MP) has emerged as a transformative advancement in organ preservation, shifting the paradigm from passive storage to active organ support. By actively circulating perfusate under controlled conditions, MP enables metabolic support, mitigation of ischemic injury, and functional assessment prior to implantation. These modalities collectively represent a paradigm shift from passive preservation toward active resuscitation and repair. This review synthesizes current advances in MP across abdominal organ transplantation, emphasizing the scientific rationale, technical evolution, organ-specific applications, and translational challenges. By examining key clinical trials, emerging biomarkers, and future directions we aim to delineate the roadmap for integrating MP into routine clinical practice and realize its full potential in expanding the donor pool and improving graft outcomes.<\/jats:p>","DOI":"10.3389\/frtra.2026.1919998","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:38:56Z","timestamp":1788788336000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Advancements in ex vivo machine perfusion for abdominal organ transplantation"],"prefix":"10.3389","volume":"5","author":[{"given":"Danae G.","family":"Olaso","sequence":"first","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria A.","family":"Bendersky","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wyeth D.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleah L.","family":"Brubaker","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Than","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel T.","family":"Schnickel","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of California San Diego","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD011671","DOI":"10.1002\/14651858.CD011671.pub3","article-title":"Normothermic and hypothermic machine perfusion preservation versus static cold storage for deceased donor kidney transplantation","volume":"2024","author":"Tingle","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.jhep.2012.10.004","article-title":"Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts","volume":"58","author":"Schlegel","year":"2013","journal-title":"J Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1056\/NEJMra2200923","article-title":"Liver transplantation","volume":"389","author":"Lucey","year":"2023","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"846","DOI":"10.3390\/jcm9030846","article-title":"Ischemia-Reperfusion injury in marginal liver grafts and the role of hypothermic machine perfusion: molecular mechanisms and clinical implications","volume":"9","author":"Czigany","year":"2020","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1038\/s41581-025-00993-8","article-title":"Improving outcomes in kidney transplantation through advances in donor organ perfusion","volume":"21","author":"Hunter","year":"2025","journal-title":"Nat Rev Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1038\/s41591-023-02376-7","article-title":"Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial","volume":"29","author":"Hosgood","year":"2023","journal-title":"Nat Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1038\/s41586-018-0047-9","article-title":"A randomized trial of normothermic preservation in liver transplantation","volume":"557","author":"Nasralla","year":"2018","journal-title":"Nature"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2918","DOI":"10.1111\/cts.13409","article-title":"Controlled oxygenated rewarming as novel end-ischemic therapy for cold stored liver grafts. 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