Abstract

The number of liver transplants worldwide continues to increase each year, while the shortage of suitable donor organs persistsat a similar rate. In recent years, the dramatic rise in obesity and liver steatosis cases has further reduced donor quality globally,making it increasingly  difficult to find healthy donors. In response to growing demand, the use of marginal donor livers has become more common. However, these grafts are generally more susceptible to ischemic injury and are associated with seriouscomplications such as primary graft  dysfunction, early graft failure, and biliary complications following transplantation. To mitigate these adverse outcomes, machine perfusion (MP) technology has been developed to preserve grafts under more physiological conditions, thereby reducing ischemic injury and enabling assessment of organ function prior to transplantation. This approach particularly supports the safer use of marginal grafts and holds the potential to improve transplant success rates. This review discusses the principles of MP technology, its current and potential applications in liver transplantation, and explores innovative approaches for its future implementation.Keywords: machine perfusion, marginal donor, liver transplantation