Related Experiment Video
Updated: May 20, 2025
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Enhancing Organ Availability: Increased DCD Liver Utilization Following Implementation of a Normothermic Machine
Marwan T Idrees1, Gabriel Land1, Nicky Kathuria1
1Queensland Liver Transplant Unit, Princess Alexandra Hospital, Queensland, Australia.
Insights
Normothermic machine perfusion (NMP) significantly increased the utilization of livers from donation after circulatory death (DCD) in Queensland. This approach improved DCD liver offer acceptance and implantation rates without compromising graft outcomes.
Area of Science:
- Transplantation Medicine
- Organ Preservation Technology
- Hepatology
Background:
- Donation after circulatory death (DCD) liver utilization in Australia lags behind international benchmarks.
- Concerns regarding early graft dysfunction and ischemic cholangiopathy limit DCD liver transplantation.
- Limited organ availability and complex logistics further challenge DCD liver utilization.
Purpose of the Study:
- To evaluate the impact of introducing normothermic machine perfusion (NMP) on DCD liver utilization.
- To compare DCD liver utilization rates before and after NMP implementation.
- To assess graft outcomes associated with NMP preservation of DCD livers.
Main Methods:
- Retrospective historical-control study comparing two eras: static cold storage (SCS) and NMP.
- Included all DCD liver activity in Queensland from June 2015 to June 2021.
- Utilized DonateLife Queensland and Princess Alexandra Hospital electronic medical records for data collection.
Main Results:
- The NMP era demonstrated significantly higher rates of medically suitable DCD offers (90.5% vs. 66.1%) and formal DCD offers (88.1% vs. 61.0%).
- DCD planned retrieval rates (56.6% vs. 23.7%) and implantation rates per offer (18.8% vs. 5.9%) were substantially higher in the NMP era.
- Despite increased utilization and higher DCD risk scores, NMP did not increase rates of early allograft dysfunction, primary nonfunction, or ischemic cholangiopathy.
Conclusions:
- Normothermic machine perfusion (NMP) significantly enhances the utilization of livers from donation after circulatory death (DCD).
- NMP facilitates the acceptance and transplantation of previously unsuitable DCD livers.
- This technology improves DCD liver utilization without adversely affecting early graft function or survival.
Abstract:
In Australia, donation after circulatory death (DCD) liver utilization remains below that of comparable healthcare systems in the Northern Hemisphere, due to concerns over higher rates of early hepatocellular dysfunction/nonfunction and ischemic cholangiopathy, coupled with limited organ availability and challenging organ transport logistics. To address this, the Queensland Liver Transplant Service introduced the OrganOx Metra normothermic machine perfusion (NMP) device in 2018. Positive outcomes were initially reported for 10 livers, including five DCD livers deemed unsuitable for static cold storage (SCS). This retrospective, historical-control study evaluated whether NMP availability improved DCD liver utilization. The NMP era (June 2018 to June 2021) was compared to the SCS era (June 2015 to June 2018), with all DCD activity included, regardless of the preservation technique. Donor data were sourced from the DonateLife Queensland database, and patient outcome data were gathered from the electronic medical records of Princess Alexandra Hospital, Queensland. The NMP era showed significantly higher rates for medically suitable DCD offers(90.5% vs. 66.1%, p < 0.01), higher rates of formal DCD offers (88.1% vs. 61.0%, p < 0.01), greater DCD planned retrieval rate (56.6% vs. 23.7%, p < 0.01), and higher implantation rate as a proportion of all DCD offers (18.8% vs. 5.9%, p < 0.01). More potentially viable DCD grafts were declined because of the lack of suitable recipients, suggesting an abundance of available livers and reduced waitlist. Despite increased DCD utilization and a higher mean modified UK DCD risk score in the NMP era (1.5 vs. 0, p = 0.05), there was no increase in early allograft dysfunction, primary nonfunction, ischemic cholangiopathy, or re-transplantation.
