The Role of Machine Perfusion in Liver Transplant Surgeon Training

Liver transplantation (LT) is a complex surgical procedure, with a well-recognized learning curve. Machine perfusion (MP) has been shown to mitigate ischemia-reperfusion injury and extend graft preservation time.

We conducted a retrospective single-center study including adult patients who underwent LT between January 1, 2021, and October 16, 2025. Patients were stratified into 3 groups according to transplant surgeon experience and graft storage: group Y-MP, young surgeons (<44 years) using MP; group S-SCS, senior surgeons (>52 years) using static cold storage (SCS); and group S-MP, senior surgeons using MP (gold standard). Recipient and donor characteristics, perioperative variables, early graft function scores (primary nonfunction, early allograft dysfunction, model for early allograft function, early allograft failure simplified estimation), and postoperative laboratory parameters were analyzed and compared among groups.

A total of 136 patients were included in the analysis (37 in Y-MP, 68 in S-SCS, and 29 in S-MP). Baseline recipient characteristics and MELD scores were comparable across groups. Operative time and blood loss were significantly higher in Y-MP; however, no significant differences were observed in primary graft outcomes (primary nonfunction, early allograft dysfunction, early allograft failure simplified estimation scores) except for MEAF. Early postoperative transaminase levels were significantly lower in Y-MP compared with S-SCS, particularly on postoperative days 1 and 3.

MP clearly ameliorates organ storage and LT logistics, but it could also be considered for young surgeons' training in performing LT. MP may represent a valuable tool in the learning curve of LT, enabling progression without compromising early graft outcomes.