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Updated: Jul 21, 2026
Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Normothermic Regional Perfusion in Controlled Donation After Circulatory Death Liver Transplantation: A Systematic
Carly Mastrovangelis1, Charles Frost1, Amy Hort1,2
1Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Insights
Normothermic regional perfusion (NRP) improves controlled donation after circulatory death (cDCD) liver grafts, reducing complications like ischemic cholangiopathy. NRP cDCD liver transplants show outcomes comparable to brain dead donor (DBD) grafts.
Area of Science:
- Transplantation Surgery
- Organ Donation
- Hepatology
Background:
- Controlled donation after circulatory death (cDCD) liver grafts have lower utilization due to poorer outcomes, particularly ischemic cholangiopathy, compared to brain dead donor (DBD) grafts.
- Normothermic regional perfusion (NRP) is a technique explored to enhance the quality of cDCD liver grafts and expand the donor pool.
Purpose of the Study:
- To systematically review and meta-analyze outcomes of NRP-treated cDCD liver grafts compared to non-NRP cDCD and DBD liver grafts.
- To evaluate the efficacy of NRP in improving cDCD liver graft quality and patient survival.
Main Methods:
- Systematic review and meta-analysis.
- Comparison of outcomes between three groups: NRP cDCD livers, non-NRP cDCD livers, and DBD livers.
- Statistical analysis of key outcomes including ischemic cholangiopathy, primary non-function, and recipient survival.
Main Results:
- NRP cDCD grafts demonstrated significantly lower rates of ischemic cholangiopathy (RR=0.23), primary non-function (RR=0.51), and recipient death (HR=0.5) compared to non-NRP cDCD grafts.
- No significant difference in outcomes was observed between NRP cDCD liver donation and DBD liver donation.
- NRP effectively improved the quality of cDCD liver grafts.
Conclusions:
- Normothermic regional perfusion (NRP) significantly enhances the quality of liver grafts from controlled donation after circulatory death (cDCD) donors.
- NRP-treated cDCD liver grafts achieve outcomes comparable to those from brain dead donors (DBD).
- These findings support the expanded use of NRP in cDCD liver transplantation to address organ shortages.
Abstract:
Liver grafts from controlled donation after circulatory death (cDCD) donors have lower utilization rates due to inferior graft and patient survival rates, largely attributable to the increased incidence of ischemic cholangiopathy, when compared with grafts from brain dead donors (DBD). Normothermic regional perfusion (NRP) may improve the quality of cDCD livers to allow for expansion of the donor pool, helping to alleviate the shortage of transplantable grafts. A systematic review and metanalysis was conducted comparing NRP cDCD livers with both non-NRP cDCD livers and DBD livers. In comparison to non-NRP cDCD outcomes, NRP cDCD grafts had lower rates of ischemic cholangiopathy [RR = 0.23, 95% CI (0.11, 0.49), p = 0.0002], primary non-function [RR = 0.51, 95% CI (0.27, 0.97), p = 0.04], and recipient death [HR = 0.5, 95% CI (0.36, 0.69), p < 0.0001]. There was no difference in outcomes between NRP cDCD donation compared to DBD liver donation. In conclusion, NRP improved the quality of cDCD livers compared to their non-NRP counterparts. NRP cDCD livers had similar outcomes to DBD grafts. This provides further evidence supporting the continued use of NRP in cDCD liver transplantation and offers weight to proposals for its more widespread adoption.
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