Machine Perfusion Linked to Better Liver Graft Survival

Frasco PE, Mathur AK, Zhang N, et al. Normothermic Machine Perfusion, Patient-Centered Recovery, and Graft Survival After Donation-After-Circulatory-Death Liver Transplantation. J Am Coll Surg. September 2026.

Normothermic machine perfusion (NMP) may limit preservation-related injury in liver grafts from donors after circulatory death. Its relationship with recovery and longer-term graft outcomes remains uncertain.

Frasco et al. retrospectively reviewed 306 consecutive adult recipients at one center from 2019 through 2022, comparing NMP-preserved grafts (95 patients) with static cold storage (211 patients). The primary measure was days alive outside the hospital during the first postoperative year. Regression models evaluated recovery and graft survival, with sensitivity analyses addressing measured confounding.

Recipients in the NMP group had a median of 357 days alive outside the hospital versus 353 with cold storage (p<0.001). However, preservation method was not independently associated with this outcome after adjustment.

NMP recipients experienced lower rates of early graft dysfunction (35.8% versus 59.7%), ischemic cholangiopathy (4.2% versus 23.7%), and repeat transplantation within 2 years (0% versus 6.6%). Two-year patient survival showed no significant difference. NMP was associated with better 2-year graft survival, including in sensitivity analyses. Adjusted total costs during the first year were similar.

These single-center findings suggest a potential graft-survival benefit without an independent improvement in the primary recovery measure. The authors recommend prospective multicenter evaluation incorporating both graft outcomes and patient-centered recovery.