William C. Chapman, Andrew S. Barbas, Anthony M. D’Alessandro, Rodrigo Vianna, Chandrashekhar A. Kubal, Peter Abt, Christopher Sonnenday, Rolf Barth, Josue Alvarez-Casas, Hasan Yersiz, Devin Eckhoff, Robert Cannon, Yuri Genyk, Linda Sher, Andrew Singer, Sandy Feng, Garrett Roll, Ari Cohen, Maria B. Doyle, Debra L. Sudan, David Al-Adra, Adeel Khan, Vijay Subramanian, Nader Abraham, Kim Olthoff, Akin Tekin, Lynn Berg, Constantin Coussios, Chris Morris, Lucy Randle, Peter Friend, Stuart J. Knechtle

Normothermic Machine Perfusion of Donor Livers for Transplantation in the United States

  • Surgery
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Objective: To compare conventional low-temperature storage of transplant donor livers [static cold storage (SCS)] with storage of the organs at physiological body temperature [normothermic machine perfusion (NMP)]. Background: The high success rate of liver transplantation is constrained by the shortage of transplantable organs (eg, waiting list mortality >20% in many centers). NMP maintains the liver in a functioning state to improve preservation quality and enable testing of the organ before transplantation. This is of greatest potential value with organs from brain-dead donor organs (DBD) with risk factors (age and comorbidities), and those from donors declared dead by cardiovascular criteria (donation after circulatory death). Methods: Three hundred eighty-three donor organs were randomized by 15 US liver transplant centers to undergo NMP (n = 192) or SCS (n = 191). Two hundred sixty-six donor livers proceeded to transplantation (NMP: n = 136; SCS: n = 130). The primary endpoint of the study was “early allograft dysfunction” (EAD), a marker of early posttransplant liver injury and function. Results: The difference in the incidence of EAD did not achieve significance, with 20.6% (NMP) versus 23.7% (SCS). Using exploratory, “as-treated” rather than “intent-to-treat,” subgroup analyses, there was a greater effect size in donation after circulatory death donor livers (22.8% NMP vs 44.6% SCS) and in organs in the highest risk quartile by donor risk (19.2% NMP vs 33.3% SCS). The incidence of acute cardiovascular decompensation at organ reperfusion, “postreperfusion syndrome,” as a secondary outcome was reduced in the NMP arm (5.9% vs 14.6%). Conclusions: NMP did not lower EAD, perhaps related to the inclusion of lower-risk liver donors, as higher-risk donor livers seemed to benefit more. The technology is safe in standard organ recovery and seems to have the greatest benefit for marginal donors.

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