Machine perfusions in liver transplantation: The evidence-based position paper of the italian society of organ and tissue transplantation

Background and aims: The use of machine perfusion in liver transplantation is spreading worldwide but its efficacy has not been demonstrated and its proper clinical use far to be implemented. The Italian Society of Organ and Tissue Transplantation (SITO) promoted the development of an evidence-based position paper. Methods: A three-step approach has been adopted to develop this position paper. Firstly, the Society appointed a Chair and a co-Chair who then assembled a Working Group with specific experience of machine perfusion in liver transplantation. The Guideline Development Group framed the clinical questions into a Patient/Intervention/Control/Outcome (PICO) format, extracted and analyzed available literature, ranked the quality of evidence, prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and voted by Delphi round by an Internal Review Board and finally evaluated and scored by a panel of external reviewers. Results: All available literature was analyzed, and its quality ranked. Eighteen recommendations regarding the use and the efficacy of ex-situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex-situ machine perfusion were prepared and graded according to the GRADE method. Conclusion: A critical and scientific approach is required for the safe implementation of this new technology.