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. 2025 May 1;281(5):872-883.
doi: 10.1097/SLA.0000000000006634. Epub 2025 Jan 20.

Normothermic Liver Machine Perfusion at a Large European Center: Real-world Outcomes following 238 Applications

Felix J Krendl  1 , Benno Cardini  1 , Margot Fodor  1 , Jessica Singh  1 , Florian Ponholzer  1 , Franka Messner  1 , Annemarie Weissenbacher  1 , Thomas Resch  1 , Manuel Maglione  1 , Christian Margreiter  1 , Stephan Eschertzhuber  2 , Christian Irsara  3 , Andrea Griesmacher  3 , Harald Schennach  4 , Robert Breitkopf  5 , Lisa Schlosser  6 , Heinz Zoller  7   8 , Herbert Tilg  7 , Rupert Oberhuber  1 , Stefan Schneeberger  1
Affiliations

Normothermic Liver Machine Perfusion at a Large European Center: Real-world Outcomes following 238 Applications

Felix J Krendl et al. Ann Surg. .

Abstract

Objective: To report outcomes from routine clinical practice of liver transplantation (LT) following normothermic liver machine perfusion (NLMP) and compare to LT after static cold storage (SCS).

Background: NLMP is emerging as a clinical routine in LT and has recently received renewed attention; however, outcomes outside of clinical trials are lacking.

Methods: All adult LT between February 2018 and January 2023 were included. A comprehensive viability assessment was applied during NLMP. Outcomes were compared between NLMP and SCS recipients, as well as benchmark and non-benchmark cases.

Results: Of the 332 LT included, 174 underwent NLMP and 158 were transplanted after SCS. Sixty-seven organs were accepted and transplanted only under the premise of NLMP. One-year graft survival for SCS and NLMP recipients was 83.8% versus 81.3% and 93.4% for benchmark cases in the overall cohort. Total preservation time had no influence on graft survival in the NLMP group but was associated with inferior 1-year graft survival in the SCS group. NLMP usage increased significantly over the duration of the study period, as did the median total preservation time. With increasing NLMP use and longer preservation times, nighttime surgery decreased significantly from 41.9% to 4.2%.

Conclusions: Prolonged preservation times ease logistics and enable daytime surgery. The possibility of NLMP offers to expand LT without negatively affecting outcomes.

Keywords: graft preservation time; graft utilization; liver transplantation; nighttime surgery; normothermic machine perfusion.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The proportion of DCD grafts transplanted increased over the duration of the study period.
FIGURE 2
FIGURE 2
The development of NLMP (A) and total preservation time (B) over the duration of the study period is depicted. Median NLMP and total preservation times for each study year with IQR in parentheses are shown. IQR indicates interquartile range.
FIGURE 3
FIGURE 3
Kaplan-Meier survival curves showing 1 and 3-year graft survival for NLMP versus SCS (A) and benchmark versus non-benchmark cases (B).
See this image and copyright information in PMC

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