• A Hann, H Lembach, A Nutu, B Dassanayake, S Tillakaratne, S C McKay, A P C S Boteon, Y L Boteon, H Mergental, N Murphy, M N Bangash, NeilD A HDAH0000-0001-9800-6811Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., J L Issac, N Javed, T Faulkner, D Bennet, R Moore, S Vasanth, G Subash, J Cuell, R Rao, H Cilliers, S Russel, G Haydon, D Mutimer, K J Roberts, D F Mirza, J Ferguson, D Bartlett, J R Isaac, N Rajoriya, M J Armstrong, H Hartog, and PereraM T P RMTPR0000-0002-5417-3850Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK..
• Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
• Br J Surg. 2022 Mar 15; 109 (4): 372-380.

BackgroundRetransplantation candidates are disadvantaged owing to lack of good-quality liver grafts. Strategies that can facilitate transplantation of suboptimal grafts into retransplant candidates require investigation. The aim was to determine whether late liver retransplantation can be performed safely with suboptimal grafts, following normothermic machine perfusion.MethodsA prospectively enrolled group of patients who required liver retransplantation received a suboptimal graft preserved via normothermic machine perfusion. This group was compared with both historical and contemporaneous cohorts of patient who received grafts preserved by cold storage. The primary outcome was 6-month graft and patient survival.ResultsThe normothermic machine perfusion group comprised 26 patients. The historical (cold storage 1) and contemporaneous (cold storage 2) groups comprised 31 and 25 patients respectively. The 6-month graft survival rate did not differ between groups (cold storage 1, 27 of 31, cold storage 2, 22 of 25; normothermic machine perfusion, 22 of 26; P = 0.934). This was despite the normothermic machine perfusion group having significantly more steatotic grafts (8 of 31, 7 of 25, and 14 of 26 respectively; P = 0.006) and grafts previously declined by at least one other transplant centre (5 of 31, 9 of 25, and 21 of 26; P < 0.001).ConclusionIn liver retransplantation, normothermic machine perfusion can safely expand graft options without compromising short-term outcomes.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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