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Updated: Aug 6, 2026
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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Overall Outcomes of Liver Transplantation Using Upfront Normothermic Machine Perfusion: A Real-World Single-Center
Michelle C Nguyen1, Stephanie Y Ohara1, Michele Barnhill2
1Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Annals of Surgery
|July 22, 2026
Summary
Normothermic machine perfusion (NMP) for donation after circulatory death (DCD) liver transplants shows survival rates comparable to donation after brain death (DBD) livers. This approach mitigates the historical survival disadvantage associated with DCD liver grafts.
Area of Science:
- Hepatology and Transplant Surgery
- Organ Preservation Techniques
- Graft Survival Analysis
Background:
- Donation after circulatory death (DCD) liver transplantation historically has lower survival rates than donation after brain death (DBD) liver transplantation.
- Normothermic machine perfusion (NMP) has shown promise in improving DCD liver transplant outcomes compared to static cold storage (SCS).
- Uncertainty remains whether NMP completely eliminates the survival disparity between DCD and DBD liver grafts.
Purpose of the Study:
- To evaluate if normothermic machine perfusion (NMP) can overcome the historical survival disadvantage of DCD liver transplantation compared to DBD liver transplantation.
- To compare the outcomes of DCD liver grafts preserved with NMP against those preserved with SCS, and against DBD liver grafts preserved with either SCS or NMP.
Main Methods:
- Retrospective cohort study of adult liver transplants (LT) conducted between 2019 and 2024 at a high-volume US center.
- Comparison of outcomes between DCD-NMP, DCD-SCS, DBD-SCS, and DBD-NMP liver grafts.
- Primary endpoints included 1-year graft and patient survival; secondary endpoints included early allograft dysfunction (EAD), hepatic artery thrombosis (HAT), primary nonfunction (PNF), biliary anastomotic strictures (BAS), and ischemic cholangiopathy (IC).
Main Results:
- DCD-NMP grafts, despite a higher donor risk profile, achieved 1-year graft survival of 94% and patient survival of 98%, comparable to DBD grafts (93% graft, 94-95% patient survival).
- DCD-SCS grafts showed significantly worse outcomes, with increased hazards for graft loss (aHR: 2.48) and death (aHR: 2.39) compared to DCD-NMP.
- EAD was significantly lower in DCD-NMP (21.7%) versus DCD-SCS (50.2%), and comparable to DBD grafts (21.1-26.4%). Ischemic cholangiopathy was less frequent with DCD-NMP (7.7%) than DCD-SCS (22%).
Conclusions:
- Normothermic machine perfusion (NMP) facilitates the safe use of DCD liver allografts.
- NMP enables DCD liver transplantation to achieve graft and patient survival rates comparable to DBD liver transplantation.
- These findings support the routine clinical integration and standardization of NMP for DCD liver transplantation.
