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Updated: Apr 1, 2026

Ex Situ Normothermic Machine Perfusion of Donor Livers
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Expanding Pediatric Liver Transplant Options: On-pump Split Reduction With Normothermic Machine Perfusion.

Alexander Kroemer1, Dimitrios Moris1, Kieranjeet Nijhar1

  • 1MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC.

Transplantation
|March 30, 2026
PubMed
Summary

This study shows that reducing a donor liver during normothermic machine perfusion (NMP) is feasible for pediatric liver transplantation. This technique offers potential benefits for graft assessment and preservation in young recipients.

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Area of Science:

  • Organ transplantation
  • Pediatric surgery
  • Machine perfusion technologies

Background:

  • Reduced-size and split liver transplantation are vital for pediatric organ shortages.
  • Traditional static cold storage limits graft tolerance and assessment.
  • Normothermic machine perfusion (NMP) offers active graft preservation but hasn't been used for pediatric liver reduction.

Purpose of the Study:

  • To report the first-in-human use of on-pump liver reduction during NMP for pediatric liver transplantation.
  • To evaluate the feasibility and outcomes of this novel approach.

Main Methods:

  • An 8-year-old donor liver was procured and preserved using NMP.
  • The liver was surgically reduced to a left lateral segment on the perfusion system.
  • The reduced graft was transplanted into a 2-month-old infant.

Main Results:

  • The transplant was technically successful.
  • Prompt recovery of graft function was observed post-transplant.
  • No immediate complications related to perfusion were noted.

Conclusions:

  • On-pump liver reduction during NMP is feasible in pediatric liver transplantation.
  • This approach may enhance graft assessment, reduce ischemia, and improve surgical precision.
  • This represents a significant advancement in pediatric organ utilization.