Continuous normothermic machine perfusion is independently associated with lower risk of acute kidney injury and renal replacement therapy in donation after circulatory death liver transplantation: a propensity score matched analysis.

Authors

Hani M Wadei, Ibrahim Al Hayani, Walid Haddad, Ramez Ibrahim, George Zakour, C Burcin Taner, Shennen A Mao, Amit Mathur, Bashar Aqel, Hasan Khamash, Andrew Keaveny, Marina T Wadei, Alexander P Hochwald, Roaa Ghanem, Yara Alnaber, Kristopher P Croome

Published in

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

Donation after circulatory death (DCD) liver transplants (LT) is associated with increased risk of post-LT acute kidney injury (AKI). This retrospective study aimed to examine the effect of continuous normothermic machine perfusion (NMP) on the incidence and stage of AKI in DCD-LT. Incidence of AKI within 48-hours was compared between 507 NMP-DCD and 472 static cold storage (SCS)-DCD LT transplanted between 1/1/2016 and 12/31/2024. AKI developed in 337 (34%) patients. On univariate analysis, AKI rate was lower in NMP-DCD compared to SCS-DCD (28% vs. 41%,p<0.001). Stage 2 and stage 3 AKI at 48-hours and renal replacement therapy (RRT) within the first 3 weeks were also lower in NMP-DCD compared to SCS-DCD (p<0.001). After adjusting for multiple recipient, donor and intra-operative factors using multivariate logistic regression, NMP-DCD was independently associated with a 37% lower odds of AKI (aOR:0.63, CI:0.46-0.85, p=0.003) and 55% lower odds stage 2 and 3 AKI (aOR:0.45, CI:0.29-0.69, p<0.001) compared to SCS-DCD. To mitigate for the era effect and other unmeasured confounders, an inverse probability of treatment weighting (IPTW) analysis was performed using a propensity score model with average treatment effect (ATE). After weighting for multiple factors, NMP-DCD was associated with lower odds of AKI at 48-hours (OR:0.65, CI: 0.53-0.81, p=0.001), stage 2 and stage 3 AKI at 48-hours (OR: 0.60, CI: 0.42-0.85, p=0.02) and RRT at day 7 (OR:0.31, CI:0.13-0.65, p=0.003) compared to SCS-DCD. In conclusion, compared to SCS-DCD, NMP-DCD was independently associated with lower odds of AKI at 48-hours, of stage 2 and stage 3 AKI at 48-hours from LT and of RRT requirement at day 7 from LT, an effect that extended for the first 3 post-LT weeks.

PMID:
42467995
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.