Pharmacological agents for defatting livers by normothermic machine perfusion

Background Ex‐vivo normothermic machine perfusion (NMP) preserves the liver metabolism at 37°C and has rapidly developed as a promising approach for assessing the viability and improving the performance of organs from expanded criteria donors, including fatty liver grafts. NMP is an effective method for defatting fatty livers when combined with pharmaceutical therapies. Pharmacological agents have been shown to facilitate liver defatting by NMP. Observations This systematic review summarizes available pharmacological therapies for liver defatting, with a particular emphasis on defatting agents that can be employed clinically as defatting components during liver NMP as an ex vivo translational paradigm. Conclusion NMP provides an opportunity for organ treatment and can be used as a defatting platform in the future with defatting agents. Nagrath's cocktail is the most commonly used defatting cocktail in NMP; however, its carcinogenic components may limit its clinical application. Thus, the combination of a defatting cocktail with a new clinically applicable component, for example, a polyphenolic natural compound, may be a novel pharmacological option. NMP provides an opportunity for liver treatment prior to liver transplantation and is extremely effective as a defatting platform with defatting drugs. It has been demonstrated that Nagrath's cocktail effectively defats steatosis livers with NMP; however, its controversial and carcinogenic components may limit its clinical application. Thus, the combination of a defatting cocktail with a novel component such as polyphenolic natural nutraceuticals could provide a novel pharmacological option.