Making Every Liver Count: Increased Transplant Yield Of Donor Livers Through Normothermic Machine Perfusion
*Malcolm MacConmara1, *Steven I Hanish1, *Christine S Hwang1, *Lucia DeGregoria1, *Dev Desai1, *Bekir Tanriover1, James F Markmann2, Herbert Zeh, III1, *Parsia A Vagefi1
1University of Texas Southwestern Medical Center, Dallas, TX;2Massachusetts General Hospital, Boston, MA
Normothermic machine perfusion (NMP) enables optimized ex-vivo preservation of a donor liver in a normal physiologic state. The impact of this emerging technology on donor liver utilization has yet to be assessed.
The UNOS STARfile database was queried to identify deceased donor livers procured from 2016-2019 (n=30596). Donor livers were divided by preservation method: standard cold-static preservation (COLD, n=30,368) vs NMP (n=228). Donor and recipient risk factors, liver disposition and discard reasons were analyzed. Transplant outcomes were compared between groups.
4037 livers were discarded. The NMP group had a 3.5% discard rate vs 13.3% in the COLD group (p<0.001), and this was despite NMP donors being older (48 v 39 years, p<0.0001), more frequently donation after cardiac death (DCD) (18% v 7%, p<0.001), and having a greater donor risk index (DRI) (1.5 v 1.4, p<0.001). The most common reasons for liver discard in the COLD group were biopsy findings (38%), DCD warm ischemic time (11%), and prolonged preservation time (10%). Survival analysis, following propensity score matching, found no significant difference in 1-year overall survival between recipients of NMP vs COLD livers.
NMP reduces the discard rate of procured livers, and despite its use in donors traditionally considered of more marginal quality, NMP maintains excellent survival. Broader application of NMP technology holds the potential to generate a significant number of additional liver grafts for transplantation every year, thus greatly reducing the nationwide disparity between supply and demand.
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