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
. 2025 Jul 16;15(7):1112.
doi: 10.3390/life15071112.

Hypothermic Machine Perfusion Is Associated with Improved Short-Term Outcomes in Liver Transplantation: A Retrospective Cohort Study

Alexandru Grigorie Nastase  1   2 , Alin Mihai Vasilescu  1   2 , Ana Maria Trofin  1   2 , Mihai Zabara  1   2 , Ramona Cadar  1   2 , Ciprian Vasiluta  2 , Nutu Vlad  1   2 , Bogdan Mihnea Ciuntu  1   2 , Corina Lupascu Ursulescu  1   3 , Cristina Muzica  1   4 , Irina Girleanu  1   4 , Iulian Buzincu  1   5 , Florin Iftimie  1 , Cristian Dumitru Lupascu  1   2
Affiliations

Hypothermic Machine Perfusion Is Associated with Improved Short-Term Outcomes in Liver Transplantation: A Retrospective Cohort Study

Alexandru Grigorie Nastase et al. Life (Basel). .

Abstract

Introduction: Liver transplantation remains the definitive treatment for end-stage liver disease but faces critical challenges including organ shortages and preservation difficulties, particularly with extended criteria donor (ECD) grafts. Hypothermic machine perfusion (HMP) represents a promising alternative to traditional static cold storage (SCS).

Methods: This retrospective study analyzed outcomes from 62 liver transplant recipients between 2016 and 2025, comparing 8 grafts preserved by HMP using the Liver Assist® system and 54 grafts preserved by SCS. Parameters assessed included postoperative complications, hemodynamic stability, ischemia times, and survival outcomes.

Results: HMP significantly reduced surgical (0% vs. 75.9%, p = 0.01) and biliary complications (0% vs. 34.4%, p = 0.004), improved hemodynamic stability post-reperfusion (∆MAP%: 1 vs. 21, p = 0.006), and achieved superior one-year survival rates (100% vs. 84.4%). Despite longer ischemia periods, grafts treated with HMP exhibited fewer adverse effects from ischemia-reperfusion injury.

Discussion: These findings highlight the substantial benefits of HMP, particularly in improving graft quality from marginal donors and reducing postoperative morbidity. Further adoption of this technology could significantly impact liver transplantation outcomes by expanding the viable donor pool.

Conclusions: The study underscores the effectiveness of hypothermic machine perfusion (HMP) as a superior preservation method compared to traditional static cold storage (SCS), HMP appears to be associated with improved short-term outcomes in liver transplantation. By substantially reducing postoperative complications and enhancing graft viability, HMP emerges as a pivotal strategy for maximizing the use of marginal donor organs. Further research and broader clinical implementation are recommended to validate these promising results and to fully harness the potential of HMP in liver transplantation.

Keywords: hypothermic machine perfusion; ischemia-reperfusion injury; liver transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hipothermic machine perfusion of the liver graft—Liver Assist® system (Organ Assist, Groningen, The Netherlands).
Figure 2
Figure 2
Impact of surgical complications survival curve—Kaplan-Meier.
Figure 3
Figure 3
Impact of postreperfusion injury survival curve—Kaplan-Meier.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Berenguer M., de Martin E., Hessheimer A.J., Levitsky J., Maluf D.G., Mas V.R., Selzner N., Hernàndez-Èvole H., Lutu A., Wahid N., et al. European Society for Organ Transplantation Consensus Statement on Biomarkers in Liver Transplantation. Transpl. Int. 2023;36:11358. doi: 10.3389/ti.2023.11358. - DOI - PMC - PubMed
    1. Chen Z., Wang T., Chen C., Zhao Q., Ma Y.M., Guo Y.M., Hong X.M., Yu J., Huang C., Ju W., et al. Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling. Transplantation. 2022;106:1193–1200. doi: 10.1097/TP.0000000000003945. - DOI - PMC - PubMed
    1. Pandya K., Sastry V., Panlilio M.T., Yip T.C.F., Salimi S., West C., Virtue S., Wells M., Crawford M., Pulitano C., et al. Differential Impact of Extended Criteria Donors After Brain Death or Circulatory Death in Adult Liver Transplantation. Liver Transpl. 2020;26:1603–1617. doi: 10.1002/lt.25859. - DOI - PubMed
    1. Banker A., Bhatt N., Rao P.S., Agrawal P., Shah M., Nayak M., Mohanka R. A Review of Machine Perfusion Strategies in Liver Transplantation. J. Clin. Exp. Hepatol. 2023;13:335–349. doi: 10.1016/j.jceh.2022.08.001. - DOI - PMC - PubMed
    1. Jing L., Yao L., Zhao M., Peng L.-P., Liu M. Organ preservation: From the past to the future. Acta Pharmacol. Sin. 2018;39:845–857. doi: 10.1038/aps.2017.182. - DOI - PMC - PubMed

LinkOut - more resources