Improved Outcomes and Resource Use With Normothermic Machine Perfusion in Liver Transplantation

Area of Science:

• Transplantation research
• Organ preservation techniques
• Clinical outcomes analysis

Background:

• Normothermic machine perfusion (NMP) is increasingly used in liver transplantation (LT) to reduce complications.
• Real-world clinical data on NMP's impact, especially comparing donation after brain death (DBD) and donation after circulatory death (DCD) allografts, is limited.

Purpose of the Study:

• To compare liver transplant outcomes between DBD and DCD allografts preserved with NMP versus static cold storage (SCS).
• To evaluate the impact of NMP on early allograft dysfunction, resource utilization, and survival rates.

Main Methods:

• Retrospective observational cohort study of 1086 adult LTs at a single center (Mayo Clinic, Arizona) from January 2019 to December 2023.
• Comparison of outcomes across four groups: DBD-SCS, DBD-NMP, DCD-SCS, and DCD-NMP.
• Analysis of primary outcomes including early allograft dysfunction (EAD), intraoperative transfusion, length of stay (LOS), and readmissions.

Main Results:

• Normothermic machine perfusion (NMP) significantly reduced early allograft dysfunction (EAD) rates, especially in DCD allografts (17.5% for DCD-NMP vs. 50.0% for DCD-SCS).
• NMP was associated with lower intraoperative transfusion needs, shorter hospital and ICU LOS, and reduced readmission rates compared to SCS.
• NMP demonstrated a significant reduction in graft failure (78% overall, 87% for DCD) and was protective against patient mortality.

Conclusions:

• Normothermic machine perfusion (NMP) substantially improves liver transplant clinical outcomes and decreases hospital resource utilization, particularly for DCD allografts.
• NMP offers a promising strategy to enhance access to liver transplantation by mitigating challenges associated with DCD liver utilization.