Normothermic Machine Perfusion, Patient-Centered Recovery, and Graft Survival After Donation-After-Circulatory-Death Liver Transplantation.

Authors

Peter E Frasco, Amit K Mathur, Nan Zhang, Bayley Brennan, Caroline Jadlowiec, Adam J Milam, Michelle K Nguyen, Megan Fah, Bhavesh M Patel, Layne M Bettini, Ruchita Dholakia, Bijan Borah, Michele Barnhill, Bashar Aqel

Published in

Journal of the American College of Surgeons. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

Normothermic machine perfusion (NMP) may reduce preservation injury in donation-after-circulatory-death (DCD) liver transplantation, but its association with patient-centered recovery and longer-term graft survival remains uncertain.
We retrospectively analyzed 306 consecutive adult DCD liver transplant recipients at a single center from January 2019 through December 2022, comparing NMP (n=95) with static cold storage (SCS; n=211). The primary endpoint was days alive and out of hospital at 365 days (DAOH365). Quasi-Poisson regression evaluated factors associated with DAOH365, and Cox regression evaluated graft survival. Propensity-matched and calendar-year sensitivity analyses assessed measured confounding.
Median DAOH365 was 357.0 (352.0, 360.0) days with NMP versus 353.0 (336.0, 359.0) with SCS (p<0.001), but preservation strategy was not independently associated with DAOH365 (adjusted rate ratio 1.02; p=0.331). NMP recipients had less early allograft dysfunction (35.8% vs 59.7%; p<0.001), ischemic cholangiopathy (4.2% vs 23.7%; p<0.001), and retransplantation within 2 years (0.0% vs 6.6%; p=0.007). Two-year patient survival did not differ significantly. NMP was associated with improved twoF-year graft survival (HR 2.9, 95% CI 1.23-6.87; p=0.015), an association maintained in propensity-matched and calendar-year sensitivity analyses. Adjusted total 1-year costs did not differ (p=0.512).
In this single-center DCD cohort, NMP was associated with superior 2-year graft survival but not independently with DAOH365. These hypothesis-generating findings support multicenter prospective evaluation of NMP using both graft survival and patient-centered recovery endpoints.

PMID:
42770976
Bibliographic data and abstract were imported from PubMed on 22 Sep 2026.

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