TY - JOUR
T1 - Normothermic Machine Perfusion of Donor Livers for Transplantation in the United States
T2 - A Randomized Controlled Trial
AU - Chapman, William C.
AU - Barbas, Andrew S.
AU - D'Alessandro, Anthony M.
AU - Vianna, Rodrigo
AU - Kubal, Chandrashekhar A.
AU - Abt, Peter
AU - Sonnenday, Christopher
AU - Barth, Rolf
AU - Alvarez-Casas, Josue
AU - Yersiz, Hasan
AU - Eckhoff, Devin
AU - Cannon, Robert
AU - Genyk, Yuri
AU - Sher, Linda
AU - Singer, Andrew
AU - Feng, Sandy
AU - Roll, Garrett
AU - Cohen, Ari
AU - Doyle, Maria B.
AU - Sudan, Debra L.
AU - Al-Adra, David
AU - Khan, Adeel
AU - Subramanian, Vijay
AU - Abraham, Nader
AU - Olthoff, Kim
AU - Tekin, Akin
AU - Berg, Lynn
AU - Coussios, Constantin
AU - Morris, Chris
AU - Randle, Lucy
AU - Friend, Peter
AU - Knechtle, Stuart J.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - 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.
AB - 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.
KW - liver
KW - normothermic
KW - perfusion
KW - preservation
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85170422210&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005934
DO - 10.1097/SLA.0000000000005934
M3 - Article
C2 - 37389552
AN - SCOPUS:85170422210
SN - 0003-4932
VL - 278
SP - E912-E921
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -