Normothermic Machine Perfusion Enabling Transplantation of a Declined Marginal Donor Liver: A Narrative Review of Organ Utilisation and Viability Assessment
DOI:
https://doi.org/10.5281/zenodo.22237549Keywords:
Liver Transplantation, Normothermic Machine Perfusion, Marginal Donor Organs, Viability Assessment, Organ UtilisationAbstract
The shortage of transplantable livers is partly a shortage of confidence. Organs are declined because nobody can tell whether
they will work, and a liver on ice gives no information while it deteriorates. Perfusing it at body temperature does the opposite: it
preserves function and lets that function be measured. Objectives: To review the published evidence on normothermic machine perfusion in liver transplantation: what it changes in graft injury, organ utilisation and preservation time, what it does not change, and how viability assessment alters the decision to accept a marginal organ. Material and Methods: Narrative review of randomised trials, viability assessment series, registry analyses and consensus guidance indexed in PubMed and the major transplantation and general medical journals. No new patient data were generated; every estimate quoted is one published by the original investigators.
Results: In a randomised trial of 220 liver transplantations across seven European centres, normothermic perfusion was
associated with a 50 per cent lower level of graft injury measured by hepatocellular enzyme release, despite a 50 per cent lower
rate of organ discard and a 54 per cent longer mean preservation time (11 hours 54 minutes against 7 hours 45). Early allograft
dysfunction and post-reperfusion syndrome were reduced. There was no significant difference in bile duct complications, graft
survival or patient survival, and median intensive care and hospital stays were similar. Conclusion: The mechanism of benefit is best understood as information rather than preservation alone: perfusion allows a liver to be tested before it is committed, which is why discard fell while injury also fell. Survival benefit has not been demonstrated, and claiming it overstates what the trials show.
Abbreviations: AST – Aspartate Transaminase, DBD – Donation after Brainstem Death, DCD – Donation after Circulatory
Death, EAD – Early Allograft Dysfunction, NMP – Normothermic Machine Perfusion, SCS – Static Cold Storage.
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