Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 1;278(5):e922-e929.
doi: 10.1097/SLA.0000000000006032. Epub 2023 Aug 15.

Impact of Portable Normothermic Machine Perfusion for Liver Transplantation From Adult Deceased Donors

Takayuki Yamamoto  1 , Srilakshmi Atthota  1 , Divyansh Agarwal  1 , Kerry Crisalli  1 , Malcolm MacConmara  2 , Tsukasa Nakamura  1 , Richard Teo  1 , Leigh Anne Dageforde  1 , Shoko Kimura  1 , Nahel Elias  1 , Heidi Yeh  1 , Adel Bozorgzadeh  1 , Tatsuo Kawai  1 , James F Markmann  1
Affiliations

Impact of Portable Normothermic Machine Perfusion for Liver Transplantation From Adult Deceased Donors

Takayuki Yamamoto et al. Ann Surg. .

Abstract

Objective: To assess how liver allografts preserved using portable normothermic machine perfusion (NMP) compare against those that underwent ischemic cold storage (ICS) in the setting of donation after brain death (DBD) and donation after circulatory death (DCD) liver transplantation (LT).

Background: Compared with conventional ICS, NMP may offer more homeostatic preservation, permit physiological assessment of organ function, and provide opportunities for graft improvement/modification. We report a single-center US experience of liver NMP.

Methods: A single-center, retrospective analysis of collected data on 541 adult whole LTs from 469 DBD donors [NMP (n = 58) vs ICS (n = 411)] and 72 DCD donors [NMP (n = 52) vs ICS (n = 20)] between January 2016 and December 2022.

Results: In DBD LT, male sex [odds ratio (95% CI): 1.83 (1.08-3.09)] and >10% macrosteatosis of the donor liver [1.85 (1.10-3.10)] were statistically significant independent risk factors of early allograft dysfunction (EAD). Donor age >40 years and cold ischemia time >7 hours were independent risk factors of reperfusion syndrome (RPS). One-year, 3-year, and 5-year incidences of ischemic cholangiopathy (IC) did not differ significantly in DBD cases between the NMP and ICS cohorts. In DCD LT, NMP was an independent protective factor against EAD [0.11 (0.03-0.46)] and RPS [0.04 (0.01-0.25)]. The incidence of IC in the DCD cases at 1-year and 3-year time points was significantly lower in the NMP cohort (1.9% compared with 20% in the ICS group).

Conclusions: Compared with conventional ICS, NMP can significantly reduce the incidence of EAD, RPS, and IC after DCD LT.

PubMed Disclaimer

Conflict of interest statement

M.M. is an employee of Transmedics OCS. J.F.M. serves on the Transmedics Clinical Advisory Board. The remaining authors report no conflicts of interest.

Comment in

References

    1. Kwong AJ, Ebel NH, Kim WR, et al. OPTN/SRTR 2020 annual data report: liver. Am J Transplant. 2022;22(suppl 2):204–309.
    1. Nasralla D, Coussios CC, Mergental H, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557:50–56.
    1. Markmann JF, Abouljoud MS, Ghobrial RM, et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS-liver PROTECT randomized clinical trial. JAMA Surg. 2022;157:189–198.
    1. Gaurav R, Butler AJ, Kosmoliaptsis V, et al. Liver transplantation outcomes from controlled circulatory death donors: SCS vs in situ NRP vs ex situ NMP. Ann Surg. 2022;275:1156–1164.
    1. Ito T, Naini BV, Markovic D, et al. Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients. Am J Transplant. 2021;21:614–625.