Related Experiment Video
Updated: Aug 6, 2026
12:13
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Comparing Early Graft Dysfunction Scores in Liver Transplantation After Ex-Situ Normothermic Machine Perfusion
Kejal Shah1, Sydney Castellanos2, April J Logan3
1Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Clinical Transplantation
|August 5, 2026
Summary
Early allograft dysfunction (EAD) in liver transplantation is linked to poorer outcomes, but traditional scores are unreliable in the normothermic machine perfusion (NMP) era. Pump parameters and graft characteristics can predict EAD, guiding clinical decisions for improved graft survival.
Area of Science:
- Hepatobiliary surgery
- Transplant immunology
- Organ preservation technologies
Background:
- Normothermic machine perfusion (NMP) offers a near-physiologic environment for liver grafts, potentially mitigating ischemia-reperfusion injury.
- Traditional early graft dysfunction scores developed during static cold storage (SCS) may not accurately reflect graft viability under NMP.
Purpose of the Study:
- To evaluate the validity of existing early graft dysfunction scores in the NMP era.
- To identify factors associated with early allograft dysfunction (EAD) and its impact on graft survival.
- To explore the utility of pump parameters in predicting graft outcomes during NMP.
Main Methods:
- Retrospective analysis of liver grafts transplanted after NMP between August 2022 and May 2024.
- Assessment of graft survival and correlation with early graft dysfunction scores (L-GrAFT7, MEAF).
- Identification of factors associated with EAD, including donor characteristics, perfusion parameters, and graft viability thresholds.
Main Results:
- Neither L-GrAFT7 nor MEAF scores correlated with early graft loss in the NMP cohort.
- Early allograft dysfunction (EAD) occurred in 40% of cases and was associated with significantly lower 6-month graft survival (89% vs. 100%).
- Higher donor BMI, longer ischemic/anastomosis times, post-reperfusion syndrome, and specific suboptimal pump parameters (e.g., impaired glucose metabolism, delayed lactate clearance) correlated with EAD. Grafts exceeding conventional viability thresholds were successfully transplanted.
Conclusions:
- EAD identifies a high-risk subgroup with inferior short-term graft survival in the NMP era.
- Trajectory-based dysfunction scores did not predict early graft loss.
- Perfusion parameters during NMP can aid decision-making for grafts with a higher likelihood of EAD.
