Giving the Thomas Starzl transplant state of the art lecture this year is Peter Friend, on normothermic transplantation — the ice box is now the rate limiting step, especially for extended criteria organs #TLM22 @OxTxResearch
Published trials for benefits of normothermic perfusion devices accumulating, typically reduced acute liver injury, post-reperfusion syndrome, utilisation, and preservation time - but randomisation process in this setting introduces inherent selection biases #TLM22 
Upcoming PLUS trial uses a prospective NMP arm and identical criteria retrospective control arm, given investigators unwilling to randomise higher risk of organs #TLM22
A new schema for centrally managing, assessing and repairing grafts, eg through removal of fat (and RCT on perfusion+lipid filter+pharmacological imminent in UK…) is being actively considered in the UK, SPAIN, and the US #TLM22
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