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Updated: Sep 17, 2025
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
The Use of Normothermic Machine Perfusion for Staged Combined Heart-Liver Transplant
Ye In Christopher Kwon1, Aamir Khan2, David A Bruno2
1Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Insights
This study shows that using liver normothermic machine perfusion (NMP) during staged combined heart-liver transplants (CHLT) can improve hemodynamic stability and reduce complications. This approach offers a safer option for high-risk patients needing both organs.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Combined heart-liver transplant (CHLT) is increasingly performed for patients with cardiac cirrhosis.
- Standard CHLT approaches carry risks of prolonged ischemic times, postreperfusion syndrome (PRS), and hemodynamic instability.
- Liver normothermic machine perfusion (NMP) offers a potential solution to mitigate these risks.
Abstract:
Introduction: For patients with cardiac cirrhosis, combined heart-liver transplant (CHLT) has been increasingly performed with improving outcomes. The standard heart-then-liver approach may increase ischemic times and postreperfusion syndrome (PRS) risk. Achieving adequate hemodynamic stability may also pose a challenge. To mitigate these risks, we assessed the use of liver normothermic machine perfusion (NMP) in a staged CHLT. Case Presentation: A 63-year-old male patient with diabetes, coronary artery disease, and NYHA Class III systolic heart failure presented to our center in cardiogenic shock. Subsequent liver biopsy found end-stage cirrhosis. He was bridged with an Impella 5.5 until a dual heart-liver donor became available. A standard heart transplant via redo sternotomy was performed on cardiopulmonary bypass (CPB). The chest was packed but left open in anticipation of the liver transplant. The liver was placed on NMP using the Organ Care System (TransMedics) with hepatic arterial and portal venous flows set at 350 and 0.8 mL/min, respectively. He received a staged liver transplant using the standard 'piggyback' technique, 8 h after the heart transplant. There was minimal PRS and bleeding. Total time on NMP was 16.4 h. The chest and abdomen were closed at the end of the liver transplant. The postoperative course was complicated by acute renal failure requiring temporary hemodialysis. He was eventually discharged home, is now off dialysis, and continues to do well. Summary: The NMP keeps the liver in an active metabolic state, allowing us to transplant the heart and establish optimal hemostasis to decrease blood product transfusion. This also allows time for proper postoperative fluid resuscitation and lactic acidosis clearance and helps achieve better hemodynamic stability with decreased inotrope/vasopressor doses. Additionally, the liver NMP is effective in minimizing complications related to PRS. A staged approach to CHLT using the NMP should be considered in such high-risk patients.
