Delivery of Therapeutics to Solid Organs Using Ex Vivo Machine Perfusion

The use of ex vivo machine perfusion for organ preservation has significantly improved solid organ transplantation outcomes. This modality of organ preservation has increased the donor pool and extended criteria for donor organs that would have previously been excluded from transplantation. Utilization of machine perfusion has protected donor organs from the injuries traditionally encountered by static cold storage, minimized rates of primary graft dysfunction, and even allowed for recovery of the function of marginal organs. Machine perfusion has also extended preservation periods well beyond what is considered acceptable after static cold storage for kidney, liver, lung, and hearts. The extended preservation time plus the growing use of ex vivo machine perfusion during organ procurement has introduced the potential for administering therapeutics during this period to improve organ quality and mitigate post-transplantation complications. The types of therapeutics that can be administered range from traditional pharmaceuticals to advanced therapeutics, such as gene and cell therapy. Here we review the history of organ preservation, post-transplantation complications amenable to therapeutic intervention, the types of ex vivo perfusion available, and therapeutic interventions that have been developed for administration during ex vivo perfusion.