Use of Machine Perfusion in Pediatric Liver Transplantation

Machine perfusion (MP) can help expand the donor pool, yet its use in pediatric liver transplantation (LT) has been limited. We aimed to compare the characteristics and outcomes of children undergoing LT with vs. without MP.

We retrospectively compared children (< 18 years) undergoing first LT with vs. without MP using United Network for Organ Sharing data (01/01/2016-12/31/2024). The MP group was compared to all non-MP and to propensity score matched non-MP LT recipients.

Forty MP LT recipients were compared to 3857 all non-MP and 40 matched non-MP recipients. Compared to all non-MP recipients, MP recipients had a higher laboratory MELD/PELD score (median 16.5 vs. 12.0, p = 0.03) and were more likely to receive split grafts (42.5% vs. 21.6%, p = 0.001) allocated at a national level (65.0% vs. 40.8%, p = 0.007) from older donors (median 16.0 vs. 11.0 years, p < 0.001) with longer organ preservation times (median 15.0 vs. 6.5 h, p < 0.001). Although not statistically different, DCD liver grafts were used in 20.0% of MP LTs compared to 11.1% of all non-MP LTs (p = 0.08). Compared to matched non-MP recipients, MP recipients were more likely to have ascites (47.2% vs. 19.4%, p = 0.02). There was no significant difference regarding patient or graft survival between the MP and all non-MP (p = 0.68 and p = 0.80) or the matched non-MP groups (p = 0.28 and p = 0.14).

MP can support LT in sick pediatric recipients using split grafts, while allowing for prolonged preservation times and national-level allocation at a larger radius, without impacting survival.