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Updated: Sep 23, 2026
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Machine-perfused Donation After Circulatory Death Grafts Improve Access to Liver Transplant for Primary Biliary
Aaron Kleinertz1, Ayham Asassfeh1, Badi Rawashdeh1
1Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
Background:
Primary biliary cholangitis (PBC) is a small-duct cholangiopathy that can lead to end-stage liver disease requiring liver transplantation (LT). Use of donation after circulatory death (DCD) donors in this population has been limited by historic concerns of severe biliary complications and inferior graft outcomes. Recent regulatory approval of normothermic machine perfusion (MP) technology has dramatically improved DCD utilization. However, outcomes of DCD-MP grafts in PBC recipients remain poorly defined.
Methods:
We performed a retrospective analysis of adult, first-time, deceased-donor LT recipients with PBC using the Organ Procurement and Transplantation Network registry (2015-2025). Recipients were stratified by donation after brain death with cold storage (DBD-CS), DCD-CS, and DCD-MP. Kaplan-Meier and multivariable Cox regression were used to estimate 1-y graft survival and adjusted hazard ratios. Temporal trends were assessed with Poisson regression.
Results:
Among 1604 recipients, 1311 (82%) received DBD-CS, 141 (9%) DCD-CS, and 152 (9%) DCD-MP. DCD groups had lower median Model for End-stage Liver Disease scores (P < 0.001) and less dialysis dependence at transplant (P < 0.001). Donor age was highest for DCD-MP (median 53.5 y; P < 0.001). One-year graft survival was similar across groups (DBD-CS 93.0%, DCD-CS 91.0%, DCD-MP 93.3%; log-rank P = 0.76). Adjusted analysis showed no association between donor type and 1-y graft failure (DCD-CS versus DBD-CS adjusted hazard ratio, 1.51; 95% confidence interval, 0.80-2.82; P = 0.2 and DCD-MP versus DBD-CS adjusted hazard ratio, 1.03; 95% confidence interval, 0.49-2.16; P = 0.94). DCD-MP utilization increased 108.9% annually between 2022 and 2025 (P < 0.001).
Conclusions:
DCD-MP achieved 1-y graft survival comparable to DBD-CS in PBC LT recipients, supporting broader consideration of this strategy. Rapid growth in DCD-MP utilization reflects increasing programmatic confidence in contemporary preservation practices for PBC patients.
