The potential biomarkers of organ transplantation in the era of machine perfusion: Current status, challenges, and future directions

Machine perfusion (MP) is a technology that mimics the physiological state in an ex vivo environment to preserve organs and enable their dynamic assessment. Biomarkers measured during MP hold significant promise for predicting post-transplant outcomes and guiding decisions on organ utilization. However, the clinical translation of this field is currently hindered by a lack of robust research defining the relevant biomarkers, their types, and their clinically applicable thresholds. This review outlines the development and fundamental principles of MP devices and provides a definition and classification of biomarkers. We systematically summarize and categorize potential MP biomarkers for the liver, kidney, lung, heart, and pancreas. Current research into MP biomarkers remains insufficient, and its clinical application is constrained by factors including MP platform heterogeneity and donor variability. Further studies are needed to determine the sensitivity, specificity, stability, and reproducibility, while exploring dynamic monitoring for timely assessment and intervention during MP.