Strategies and future prospects for the prevention and treatment of ischemia-reperfusion injury in liver graft

Ischemia-reperfusion injury (IRI) of the donor liver is inevitable during procurement, preservation and transplantation, directly affecting the outcome of liver transplantation. It is the main cause of early allograft dysfunction and acute/chronic graft rejection after liver transplantation. It is also the main risk factor that affects the use of marginal grafts and exacerbates donor shortage. With the rapid development of biomedical technology, continuous improvements have been made in donor liver preconditioning, preservation perfusion techniques, and pharmacological treatments. Particularly significant progress and breakthroughs have been achieved in the areas of machine perfusion technology, ischaemia-free liver transplantation, anti-oxidation, anti-apoptosis and anti-inflammatory treatments. These advances have significantly reduced or prevented IRI in donor livers, extended the preservation time of donor livers ex vivo, reduced a series of severe complications after liver transplantation, and also significantly increased the utilization rate of marginal donor livers. This article discusses the progress in mechanisms related to liver IRI and liver preservation methods, and explores existing issues, cutting-edge explorations, and future challenges in effective organ preservation and optimization.