Normothermic machine perfusion of pediatric liver allografts: A single-center case series

Pediatric liver transplant candidates face persistent donor shortages. Normothermic machine perfusion (NMP) has dramatically expanded the donor pool for adults by enabling broader use of donation after circulatory death (DCD) livers. However, the utilization of pediatric DCD livers, as well as donation after brain death livers with elevated enzymes, bilirubin, or prolonged estimated cold ischemia time, remains limited. We performed a retrospective institutional cohort analysis of 14 pediatric liver allografts from donors weighing <35 kg recovered using our adapted pediatric NMP technique (May 2025-February 2026). Nine of the 14 allografts were from DCD donors. Of those 14 allografts, 12 met our institutional viability criteria and were used for transplant. During preliminary short-term follow-up (median 94 days), no patient deaths or episodes of primary nonfunction occurred. Our study establishes a reliable technique for performing pediatric NMP and highlights its technical feasibility.