Enhancing Organ Availability: Increased DCD Liver Utilization Following Implementation of a Normothermic Machine...

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.