DOI: 10.1097/tp.0000000000005870 ISSN: 0041-1337

Propensity Score–Matched Comparison of Normothermic Machine Perfusion and Normothermic Regional Perfusion in Donation After Circulatory Death Liver Transplant

Steven A. Wisel, Tiffany Y. Lim, Michael Luu, Georgios Voidonikolas, Todd V. Brennan, Kambiz Kosari, Tsuyoshi Todo, Nicholas N. Nissen, David C.H. Kwon, Irene K. Kim, Justin A. Steggerda
Show PDF Cite

Background.

Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) have rapidly expanded donation after circulatory death (DCD) liver transplant, but comparative real-world data are lacking.

Methods.

Adult liver transplants performed in the advanced perfusion era (December 2021–June 2025) were analyzed via the Organ Procurement and Transplant Network/Standard Transplant Analysis and Research database. DCD grafts were stratified by advanced perfusion modality (DCD+NMP, DCD+NRP, or DCD+NRP+NMP) or static cold storage (DCD+SCS), and compared with donation after brain death (DBD) transplants. “Back-to-base” machine perfusion cases were excluded. Primary outcome was 2-y graft survival.

Results.

Among 26 021 liver transplants, 20 765 were DBD and 5256 were DCD (2695 DCD+NMP, 861 DCD+NRP, 645 DCD+NRP+NMP, and 1055 DCD+SCS). Hazard of 2-y graft loss was not statistically different from DBD transplants for DCD+NMP (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.99-1.35; P  = 0.069), DCD+NRP (HR, 1.14; 95% CI, 0.87-1.49; P  = 0.3), and DCD+NRP+NMP (HR, 1.04; 95% CI, 0.73-1.49; P  = 0.8) cohorts. DCD+SCS demonstrated increased hazard of 2-y graft loss (HR, 1.79; 95% CI, 1.52-2.10; P  < 0.001). Propensity score matching to DBD cohorts revealed no difference in 2-y graft survival after DCD+NMP ( P  = 0.11), DCD+NRP ( P  = 0.12), or DCD+NRP+NMP ( P  = 0.6), with inferior graft survival after DCD+SCS ( P  < 0.001). Comparison of DCD+NMP and DCD+NRP by propensity score matching showed no difference in 2-y graft survival ( P  = 0.3). Hazard of ischemic cholangiopathy was increased over DBD liver transplants for DCD+SCS (HR, 5.51; 95% CI, 2.94-10.3; P  < 0.001) and DCD+NMP (HR, 2.11; 95% CI, 1.02-4.23; P  = 0.038) but not DCD+NRP (HR, 1.27; 95% CI, 0.29-4.02; P  = 0.7) or DCD+NRP+NMP (HR, 1.04; 95% CI, 0.15-4.11; P  > 0.9).

Conclusions.

Advanced perfusion with NMP and/or NRP in DCD liver transplant demonstrates superior graft survival compared with traditional SCS, with 2-y graft survival approaching DBD outcomes. Advanced perfusion should be routinely considered in DCD liver transplant.

More from our Archive