LAUSR

L iver transplantation (LT) is one of the marvels of modern medicine. Over a period of 50 years, LT has gone from a procedure performed in desperate situations to one that is now almost routine. Along the way, we have developed a better understanding of liver failure physiology andmade major advances in all aspects of patient care, including immunosuppression, surgical and anesthesia technique, and perioperative care. In the United States, over 7000 LT were performed in 2015. Before 2015, there was a noticeable decline in the rate of transplantation. The single most significant limitation to LT is the lack of available organs. Considering that almost 15 000 patients are currently on the waiting list, increasing the number of transplantable organs must be a priority. To increase the number of transplantable organs, the use of discarded and extended criteria grafts (ECG), such as those obtained from donation after cardiac death (DCD), has increased. The number of discarded organs has been relatively stable for the last 15 years (8% to 11%, Organ Procurement and Transplantation Network data). Since the first DCD transplantation in 1993, the use of this type of graft has slowly increased in the United States, reaching 5.7 % in 2016 (OPTNdata). The relatively low utilization ofDCDorgans is because of inferior outcomes in comparison to when donation after brain death (DBD) grafts are used. We must develop strategies to ensure these grafts are of the highest quality. Continuous graft perfusion before transplantation is one of these strategies. In this issue, Compagnon et al evaluated the feasibility of using a transportable perfusion system (Airdrive) to preserve DCD liver grafts in pigs. The authors used a continuously oxygenated hypothermic pulsatile perfusion (HMP) system. This approach enables initiating graft perfusion early, subsequently shortening cold ischemia time (CIT).