Transplantology against aging:the role of machine perfusion in replacement therapy and organ restoration

Increased life expectancy without proportional increase in healthy lifespan poses a significant challenge for contemporary healthcare. There is a need to shift the focus of healthcare from treating age-related diseases to addressing the underlying factor of their development (aging). Organ-specific strategies for replacement therapy are being considered together with development of systemic anti-aging therapies. In this review, we analyze current advancements of ex situ machine perfusion not only for organ preservation prior to transplantation, but also as a platform for assessment, restoration, and modification of organs. Integration of machine perfusion with advanced biotechnologies (gene therapy, mesenchymal stem cell therapy, senotherapy, and aptamer-based biosensors for real-time monitoring of cytokines) opens new opportunities for creation of organs resistant to aging and ischemia-reperfusion injury. We discuss the impact of organ age on organismal aging rate and evaluate potential of combined approaches involving machine perfusion alongside molecular and cellular technologies as a platform for anti-aging replacement therapy.