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Updated: May 10, 2026
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Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Normothermic Machine Perfusion vs. Static Cold Storage for DBD Liver Transplantation in High-MELD Recipients: A
Yuzuru Sambommatsu1, Daisuke Imai1, Kush Savsani1
1Department of Surgery, Division of Transplant Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Journal of Hepato-Biliary-Pancreatic Sciences
|May 9, 2026
Summary
Normothermic machine perfusion (NMP) did not improve short-term outcomes for high-MELD liver transplant recipients compared to static cold storage (SCS). NMP benefits are context-dependent, varying with graft type, application model, and recipient acuity.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Preservation Technology
Background:
- Normothermic machine perfusion (NMP) offers potential advantages over static cold storage (SCS) for liver grafts.
- Its effectiveness in high-acuity liver transplant recipients (MELD score ≥ 25) using a back-to-base model requires further investigation.
Purpose of the Study:
- To compare short-term clinical outcomes of liver transplantation using NMP versus SCS in recipients with high Model for End-Stage Liver Disease (MELD) scores.
- To evaluate the efficacy of a back-to-base NMP application model in this specific patient cohort.
Main Methods:
- Retrospective cohort study of 215 adult liver transplant recipients with MELD ≥ 25 from donation after brain death (DBD) donors.
- Comparison between patients preserved with SCS (n=137) and NMP (n=78) using multivariable regression analyses.
Main Results:
- NMP group showed higher daytime surgery rates (88.5% vs. 23.4%) and lower peak ALT levels (298 vs. 653 IU/L).
- No significant differences observed in blood loss, early allograft dysfunction, acute kidney injury, complication index, hospital stay, or 90-day graft survival between NMP and SCS groups.
Conclusions:
- A back-to-base NMP approach did not enhance major short-term clinical outcomes compared to SCS in high-MELD DBD liver graft recipients.
- The clinical utility of NMP is contingent upon graft type, application strategy (upfront vs. back-to-base), and recipient acuity.
