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Updated: Jun 25, 2025
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
The Potential Utilization of Machine Perfusion to Increase Transplantation of Macrosteatotic Livers
Claire Cywes1, Amay Banker1, Nicolas Muñoz1
1Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Background:
The demand for liver transplantation has led to the utilization of marginal grafts including moderately macrosteatotic livers (macrosteatosis ≥30% [Mas30]), which are associated with an elevated risk of graft failure. Machine perfusion (MP) has emerged as a technique for organ preservation and viability testing; however, little is known about MP in Mas30 livers. This study evaluates the utilization and outcomes of Mas30 livers in the era of MP.
Methods:
The Organ Procurement and Transplantation Network database was queried to identify biopsy-proven Mas30 deceased donor liver grafts between June 1, 2016, and June 23, 2023. Univariable and multivariable models were constructed to study the association between MP and graft utilization and survival.
Results:
The final cohort with 3317 Mas30 livers was identified, of which 72 underwent MP and were compared with 3245 non-MP livers. Among Mas30 livers, 62 (MP) and 1832 (non-MP) were transplanted (utilization of 86.1% versus 56.4%, P < 0.001). Donor and recipient characteristics were comparable between MP and non-MP groups. In adjusted analyses, MP was associated with significantly increased Mas30 graft utilization (odds ratio, 7.89; 95% confidence interval [CI], 3.76-16.58; P < 0.001). In log-rank tests, MP was not associated with 1- and 3-y graft failure (hazard ratio, 0.49; 95% CI, 0.12-1.99; P = 0.319 and hazard ratio 0.43; 95% CI, 0.11-1.73; P = 0.235, respectively).
Conclusions:
The utilization rate of Mas30 grafts increases with MP without detriment to graft survival. This early experience may have implications for increasing the available donor pool of Mas30 livers.
Insights
Machine perfusion (MP) significantly increases the utilization of moderately macrosteatotic (Mas30) liver grafts without negatively impacting graft survival. This suggests MP can expand the donor pool for liver transplantation.
Area of Science:
- Hepatology
- Transplantation Medicine
- Organ Preservation
Background:
- Marginal liver grafts, including those with macrosteatosis (≥30% [Mas30]), are increasingly used due to high demand, despite elevated graft failure risks.
- Machine perfusion (MP) is a technique for organ preservation and viability testing, but its role in managing Mas30 livers is not well-established.
Purpose of the Study:
- To evaluate the utilization and outcomes of Mas30 liver grafts in the context of machine perfusion (MP).
Main Methods:
- A retrospective analysis of biopsy-proven Mas30 deceased donor liver grafts from June 2016 to June 2023 using the Organ Procurement and Transplantation Network database.
- Comparison of graft utilization and survival between Mas30 livers that underwent MP versus those that did not, using univariable and multivariable models.
Main Results:
- Out of 3317 Mas30 livers, 72 underwent MP and 3245 did not. MP significantly increased Mas30 graft utilization (86.1% vs. 56.4%, P < 0.001).
- Adjusted analyses showed MP was associated with a nearly 8-fold increase in Mas30 graft utilization (OR, 7.89; P < 0.001).
- MP was not associated with increased 1- or 3-year graft failure rates in log-rank tests.
Conclusions:
- Machine perfusion enhances the utilization of Mas30 liver grafts without compromising graft survival.
- This early experience with MP for Mas30 livers suggests a potential strategy to expand the donor pool for liver transplantation.
