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Updated: Aug 5, 2026
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Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
When Machine Perfusion Falls Short: Identifying Risks of Liver Graft Failure After Normothermic Machine Perfusion
Lauren E Matevish1, Abdullah K Malik2,3, Milana Harris1
1Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Artificial Organs
|July 18, 2026
Summary
Recipient factors, especially surgical complexity, significantly impact liver transplant graft failure after normothermic machine perfusion (NMP). Clinical judgment remains crucial for successful recipient-donor matching in NMP liver transplantation.
Area of Science:
- Hepatology
- Transplantation Surgery
- Medical Technology
Background:
- Normothermic machine perfusion (NMP) is transforming liver transplantation by expanding donor and recipient criteria.
- Limited data exists on graft and recipient factors linked to unsuccessful NMP outcomes.
Purpose of the Study:
- To identify donor and recipient factors associated with 1-year graft failure in liver transplantation using NMP.
- To analyze the impact of NMP on graft survival and identify predictors of failure.
Main Methods:
- Retrospective analysis of the Organ Procurement and Transplantation Network database (2021-2024).
- Inclusion of adult deceased donor liver transplant recipients preserved with NMP.
- Stratification by 1-year graft status and logistic regression for factor analysis.
Main Results:
- 8.1% of 4928 NMP cases experienced 1-year graft failure.
- Graft failure associated with ICU admission, complex abdominal histories (TIPS, prior surgery, prior transplant), higher MELD scores, and lower functional status.
- Alcohol-associated liver disease was the only protective factor identified.
Conclusions:
- Recipient factors, particularly surgical complexity, are more critical than donor factors in NMP graft failure.
- Despite NMP's benefits, transplant provider judgment is essential for optimal recipient-donor matching and outcomes.
