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Review
. 2025 Mar 28;87(5):2812-2828.
doi: 10.1097/MS9.0000000000003222. eCollection 2025 May.

Normothermic machine perfusion in liver transplantation: a bibliometric analysis of the top 100 most cited articles

Hiba Thasleem  1 , Muhammad Ahmad Nadeem  2 , Hamza Ashraf  3 , Ghazal Ishaque  4 , Mahinn Saadi  5 , Mansoor Ahmed  6 , Mian Zahid Jan Kakakhel  7 , Abdul Rafeh Awan  8 , Aalaa Saleh  9 , Amir H Sohail  10
Affiliations
Review

Normothermic machine perfusion in liver transplantation: a bibliometric analysis of the top 100 most cited articles

Hiba Thasleem et al. Ann Med Surg (Lond). .

Abstract

Background: Normothermic machine perfusion (NMP) has increased substantially in the recent decade, being a vital tool in further organ preservation and reducing ischemia-reperfusion injury. The purpose of this study was to objectively conduct a bibliometric analysis of the top 100 cited articles to understand the evolution of NMP in liver transplantation.

Methods: Scopus was selected as our primary database. We explored the database to extract relevant articles, which were then ranked numerically by the number of citations. A list of the top 100 articles was created in descending order, and each article was further analyzed to identify trends and characteristics. A list of the top 10 review articles was also prepared.

Results: The top 100 studies were cited a total of 6136 times from 2013 and 2023, with the most cited articles published in 2018. The total number of citations per article ranged from 7 to 787, with a median of 397 citations. The articles originated from 13 different countries, with the United Kingdom having the most articles (n = 26), followed by the Netherlands (n = 17) and the United States (n = 17). Liver Transplantation (n = 21), Transplantation (n = 10), American Journal of Transplantation (n = 10), and Annals of Surgery (n = 6) contributed to nearly half of the articles.

Conclusion: Research on NMP is rapidly growing and encompasses a variety of countries and institutions. Our analysis provides insight into the evolution of normothermic machine perfusion in liver transplantation, with the hope that this article may serve as a reference to aid healthcare professionals in efficiently assessing consensus, trends, and needs within the field.

Keywords: liver grafting; liver transplantation; normothermic machine perfusion; normothermic perfusion and hepatic grafting; normothermic preservation.

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Conflict of interest statement

More than two-thirds of the articles received funding (n = 78). It was found that the presence of funding had no significant effect on the number of citations (P = 0.987) Government institutions and agencies sponsored more than half of the funded articles (n = 58), out of which the Medical Research Council was the biggest source (n = 8). Among the private funders, Wellcome Trust sponsored the most articles (n = 9). Furthermore, most articles received institutional support from their respective affiliation. Table 6 highlights the different sources of funding. Over a third (n = 35) of articles reported a conflict of interest. However, our analysis reported no significant association between conflict of interest and number of citations of the article (P = 0.856)Table 6Type of funding with the total number of articlesType of fundingNumber of articlesPrivate20Government30Funded by both institutions28Not funded22 The overwhelming majority of the primary authors were Caucasian (n = 68), followed by Asian (n = 19) and Hispanic (n = 12). Only a single Black was the primary author. A similar trend was seen among the senior authors, with the majority being Caucasian (n = 75), followed by Asians (n = 14) and Hispanics (n = 11). No Black author held senior authorship. Figure 6 depicts a visual representation of this analysis.Figure 6.Racial distribution of the first, second, third, and last authors in the top 100 cited articles. A large number of the primary authors were males (n = 86). An identical trend was observed in the senior authorship position, primarily held by males (n = 95). We found no significant association between the gender of the first and senior authors (P = 0.274) or between the gender of the first author and the number of citations of the article (P = 0.781). Figure 7 displays the variation of gender among the first, second, third, and last authors.Figure 7.Gender distribution of the first, second, third, and last authors in the top 100 cited articles. An overwhelming majority of the articles were funded. Previous studies have shown that funding tends to result in higher citation counts.[35] No significance was established between our study’s presence or type of funding and citation count. Interestingly, most of the articles funded in our study reported positive results, and the majority came from influential organizations. Wellcome Trust had the first funding source, followed by the Medical Research Council UK and other institutes and universities. Such a funding landscape carries essential implications regarding the connection of these stakeholders and the priorities and results of the research. However, many articles mentioned that sponsors were blind to the study, except for providing funds and machine perfusion devices. This can be understandable as there are limited brands of machine perfusion devices, and the cost of purchasing or leasing the device and the staff costs of running it need to be considered.[36] Furthermore, our study revealed that more than a third of the articles reported a conflict of interest. Although our analysis showed no significant association between conflict of interest and article citation, such conflicts can skew the results.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. None declared.

Figures

Figure 1.
Figure 1.
The article selection process using Scopus database.
Figure 2.
Figure 2.
Total number of citations per year.
Figure 3.
Figure 3.
Number of articles in each 3-year interval.
Figure 4.
Figure 4.
Number of articles originating from each country.
Figure 5.
Figure 5.
Co-author citation analysis.
Figure 6.
Figure 6.
Racial distribution of the first, second, third, and last authors in the top 100 cited articles.
Figure 7.
Figure 7.
Gender distribution of the first, second, third, and last authors in the top 100 cited articles.
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