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Updated: Jun 13, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Sequential In Situ Normothermic Regional Perfusion and Ex Situ Normothermic Machine Perfusion in Controlled Donation
Rohit Gaurav1, Subhankar Paul1, Lisa Swift1
1Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Background:
Normothermic regional perfusion (NRP) has shown superior outcomes in donation after circulatory death, with a low incidence of biliary complications. Not all NRP parameters are unequivocal in supporting transplantation, and further assessment may be required using ex situ normothermic machine perfusion (NMP). Theater and recipient factors may also require extended preservation using NMP. The present study reports our experience with sequential NRP-NMP livers.
Methods:
Single-center retrospective analysis of livers undergoing both NRP and NMP, divided into cohorts based on indication for NMP: D-NRP-NMP for donor indications and R-NRP-NMP where the indication was recipient/logistical reason.
Results:
There were 70 NRP-NMP assessments between May 2017 and August 2024. Sixty-five percent (24/37) of D-NRP-NMP livers and 85% (28/33) of R-NRP-NMP livers were transplanted. Two-thirds of the livers (19/30) failing NRP lactate criteria in the D-NRP-NMP group were transplanted after favorable NMP. Similarly, 60% (9/15) of livers failing NRP alanine transaminase (ALT) cutoff criteria, including 3 livers with ALT >1000 U/L, were successfully transplanted. Collectively, 11 livers (30%) failed both lactate and ALT criteria, with NRP-NMP able to recover 7 (64%) of these livers for transplant. Overall, outcomes of NRP-NMP were satisfactory with 2% primary nonfunction, 23% Olthoff early allograft dysfunction, 56% Kidney Disease Improving Global Outcome acute kidney injury stage ≥2, and 6% nonanastomotic stricture, none requiring biliary intervention. There was no difference in transplant outcomes between the 2 groups, with similar 1- and 3-y patient and graft survival.
Conclusions:
NRP and NMP are complementary, with further NMP assessment able to use liver grafts with marginal NRP parameters or facilitating increased preservation time.
