Application of Extracorporeal Blood Purification Strategies During Ex Situ Organ Perfusion

Following the initial success of ex situ organ perfusion (ESOP) in reducing ischemia-reperfusion injury and its adverse effects in different organs for transplantation, there is increasing interest in extending the duration and scope of ESOP, to resuscitate, repair, and even modify perfused organs in isolation, for transplantation and other purposes. To maintain the stability of the perfusate and organ and remove accumulating waste products not cleared by the organ itself, techniques of extracorporeal blood purification (EBP), including hemoadsorption, hemodialysis, hemofiltration, and hemodiafiltration, have been incorporated during ESOP in different organs. This review article provides a detailed description of EBP therapies and the potential benefits of their application during ESOP. It includes evidence from both clinical and preclinical studies published to date incorporating EBP during ex situ perfusion of thoracic and abdominal organs. Overall, these studies suggest that EBP therapies applied during ESOP help to support more physiological conditions and isolated organ homeostasis, which are particularly useful in prolonging ESOP for periods lasting 24 h and beyond.