Navigating new frontiers: onsite machine perfusion in US liver transplantation.

Abstract

BACKGROUND: The increasing demand for liver transplantation (LT) necessitates optimal utilization of marginal donors including donation after cardiac death (DCD), older, and steatotic donors. Onsite machine perfusion (OMP) might make previously non-utilized organs useable. Comprehensive studies on OMP's safety in LT, using the US national database, are lacking.METHODS: This study aimed to assess OMP usage and implications in LT, using the UNOS database (2016-2023). The impact on recipient outcomes of marginal donor quality as assessed by the donor organ discard index (DSRI) was examined.RESULTS: Of 50,458 LT cases identified, 1263 (2.5%) utilized OMP. OMP usage had surged since 2022, exceeding a 10.0% proportion in early 2023 (Jan-June). In DBD, OMP livers had higher median DSRI than non-OMP livers (2.33vs1.73, P<0.01) but had comparable graft survival (GS). DCD livers had better 90-day/1-year GS when OMP was used despite having a higher DSRI (24.3vs18.6, P<0.01). For DCD donors with high DSRI (>13), OMP utilization correlated with a significantly lower hazard ratio (HR) than non-utilization. OMP cases with macrosteatosis=30% reported no graft failures. OMP did not exhibit a linear increase in HR with donor age.CONCLUSION: OMP's usage in LT significantly increased after its commercialization, offering comparable outcomes with non-OMP despite higher DSRI. It holds promise in optimizing marginal donor use, potentially expanding the donor pool.

View details for DOI 10.1016/j.hpb.2025.02.011

View details for PubMedID 40050203