Saad Ahmed MALIK, Srinivasan MUTHUKRISHNAN, Chandra Shekhar BHATI, Ruchin Bharat PATEL, Omar RAHMAN, Raphael Pascal Henri MEIER
Experimental and Clinical Transplantation - 2026;24(7):547-552
Objectives: Normothermic machine perfusion in liver transplants has emerged as a technique to preserve donor allografts, potentially improving graft quality and increasing organ availability. However, a need exists to evaluate long-term recipient and graft survival using normothermic machine perfusion. We evaluated graft survival and outcomes after liver transplant using normothermic machine perfusion. Materials and Methods: From the United Network for Organ Sharing database, we identified adult recipients (>=18 years old) of liver transplants that occurred between January 1, 2016, and December 31, 2024. The primary outcome was graft loss (retransplant or recipient death). We used Cox regression to identify graft loss predictors in the normothermic machine perfusion group versus static cold storage. Results: Among 67 447 transplants, 4385 transplant (6.5%) utilized normothermic machine perfusion. The normothermic machine perfusion donors were older, had higher body mass index (measured as kilograms body mass per meter squared), had diabetes more commonly, and were more often donors after circulatory death. After multivariable adjustment, normothermic machine perfusion showed graft survival rates comparable with static cold storage (hazard ratio, 1.019; 95% CI, 0.989-1.051; P = .218). Subgroup analysis showed that donor body mass index, donor diabetes, donor hepatitis C infection, and donation after circulatory death predicted graft loss in static cold storage recipients but not normothermic machine perfusion recipients, suggesting that normothermic machine perfusion may mitigate high-risk donor characteristics. Conclusions: Despite higher-risk donor profiles, normothermic machine perfusion liver transplants achieved graft survival rates comparable with static cold storage liver transplants. Normothermic machine perfusion may safely expand the donor pool by enabling use of marginal allografts. Prospective studies with longer follow-up are needed to optimize normothermic machine perfusion.
