Modifying organs with gene therapy and gene modulation in the age of machine perfusion

Purpose of review This review aims to highlight current advances in gene therapy methods, describing advances in CRISPR–Cas9 gene editing and RNA interference in relevance to liver transplantation, and machine perfusion. Recent findings In order to minimize rejection, increase the donor pool of available organs, and minimize the effects of ischemia–reperfusion injury, gene therapy and gene modification strategies are, thus, required in the context of liver transplantation. Summary Gene therapy has been used successfully in a diverse array of diseases, and, more recently, this technique has gained interest in the field of organ transplantation. Biological and logistical challenges reduce the rate of successful procedures, increasing the waiting list even more. We explore the exciting future implications of customized gene therapy in livers using machine perfusion, including its potential to create a future in which organs destined for transplant are individualized to maximize both graft and recipient longevity.