• Takayuki Yamamoto, Srilakshmi Atthota, Divyansh Agarwal, Kerry Crisalli, Malcolm MacConmara, Tsukasa Nakamura, Richard Teo, Leigh Anne Dageforde, Shoko Kimura, Nahel Elias, Heidi Yeh, Adel Bozorgzadeh, Tatsuo Kawai, and James F Markmann.
• Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
• Ann. Surg. 2023 Nov 1; 278 (5): e922e929e922-e929.

ObjectiveTo assess how liver allografts preserved using portable normothermic machine perfusion (NMP) compare against those that underwent ischemic cold storage (ICS) in the setting of donation after brain death (DBD) and donation after circulatory death (DCD) liver transplantation (LT).BackgroundCompared with conventional ICS, NMP may offer more homeostatic preservation, permit physiological assessment of organ function, and provide opportunities for graft improvement/modification. We report a single-center US experience of liver NMP.MethodsA single-center, retrospective analysis of collected data on 541 adult whole LTs from 469 DBD donors [NMP (n = 58) vs ICS (n = 411)] and 72 DCD donors [NMP (n = 52) vs ICS (n = 20)] between January 2016 and December 2022.ResultsIn DBD LT, male sex [odds ratio (95% CI): 1.83 (1.08-3.09)] and >10% macrosteatosis of the donor liver [1.85 (1.10-3.10)] were statistically significant independent risk factors of early allograft dysfunction (EAD). Donor age >40 years and cold ischemia time >7 hours were independent risk factors of reperfusion syndrome (RPS). One-year, 3-year, and 5-year incidences of ischemic cholangiopathy (IC) did not differ significantly in DBD cases between the NMP and ICS cohorts. In DCD LT, NMP was an independent protective factor against EAD [0.11 (0.03-0.46)] and RPS [0.04 (0.01-0.25)]. The incidence of IC in the DCD cases at 1-year and 3-year time points was significantly lower in the NMP cohort (1.9% compared with 20% in the ICS group).ConclusionsCompared with conventional ICS, NMP can significantly reduce the incidence of EAD, RPS, and IC after DCD LT.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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