From Preservation to Repair: A Systematic Review of Therapeutic Organ Rehabilitation During Normothermic Ex Vivo Machine Perfusion

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Normothermic ex vivo machine perfusion (NMP) enables active organ rehabilitation rather than passive preservation. While lung perfusion represents the most mature therapeutic paradigm, kidney, liver, and heart applications are emerging. This review examines therapeutic interventions during NMP across these organs to identify shared mechanisms and translational gaps. Methods Following PROSPERO registration (CRD420251134637), a PRISMA-compliant search of PubMed, Web of Science, and Embase identified 3336 records. After screening, 155 articles underwent full-text review for inclusion of therapeutic delivery during NMP. Data extraction captured intervention characteristics, perfusion parameters, and outcomes across predefined domains. Results Twenty-one studies met inclusion criteria: kidney (n = 12, 57%), liver (n = 8, 38%), and heart (n = 1, 5%). Models were predominantly human (n = 13, 62%) or porcine (n = 6, 29%). Interventions included pharmacologic agents (n = 12, 57%), cellular/subcellular therapies (n = 6, 29%), defatting protocols (n = 2, 10%), and circuit modifications (n = 1, 5%). Three mechanistic themes emerged: (1) mitochondrial resuscitation via agents such as AP39 preserved ATP and reduced oxidative stress; (2) immune modulation through CD47 blockade or cytokine hemoadsorption attenuated inflammation; and (3) regenerative approaches using mesenchymal stro

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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