Are we on track to increase organ utilization? An analysis of machine perfusion preservation for liver transplantation in the United States.

Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 7802778 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1594 (Electronic) Linking ISSN: 0160564X NLM ISO Abbreviation: Artif Organs Subsets: MEDLINE

Publication: Cambridge, MA : Wiley-Blackwell
Original Publication: Cleveland, International Society for Artificial Organs.

Liver Transplantation*/methods ; Liver Transplantation*/statistics & numerical data ; Organ Preservation*/methods ; Perfusion*/methods ; Perfusion*/instrumentation ; Graft Survival* ; Tissue and Organ Procurement*/methods ; Tissue and Organ Procurement*/statistics & numerical data; Humans ; United States ; Male ; Female ; Middle Aged ; Adult ; Tissue Donors/statistics & numerical data ; Tissue Donors/supply & distribution ; Aged ; Retrospective Studies

Background: Efforts to improve the quality of marginal grafts for transplantation are essential. Machine perfusion preservation appears as a promising solution.
Methods: The United Network for Organ Sharing (UNOS) database was queried for deceased liver donor records between 2016 and 2022. The primary outcome of interest was the organ nonutilization rate. Long-term graft and patient survival among extended criteria donors (ECDs) were also analyzed.
Results: During the study period, out of 54 578 liver grafts recovered for transplant, 5085 (9.3%) were nonutilized. Multivariable analysis identified normothermic machine perfusion (NMP) preservation as the only predictor associated with a reduction in graft nonutilization (OR = 0.12; 95% CI = 0.06-0.023, p < 0.001). Further analysis of ECD grafts that were transplanted revealed comparable 1-,2- and 3-years graft survival (89%/88%/82% vs. 90%/85%/81%, p = 0.60), and patient survival (92%/91%/84% vs. 92%/88%/84%, p = 0.65) between grafts that underwent MP vs. those who did not, respectively.
Conclusions: Liver nonutilization rates in the United States are at an all-time high. Available data, most likely including cases from clinical trials, showed that NMP reduced the odds of organ nonutilization by 12% among the entire deceased donor pool and by 16% among grafts from ECD. Collective efforts and further evidence reflecting day-to-day clinical practice are needed to fully reach the potential of MP for liver transplant.
(© 2024 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

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Keywords: DCD; graft nonutilization; liver transplant; machine perfusion preservation; marginal donors

Date Created: 20240722 Date Completed: 20241014 Latest Revision: 20241014

20241015

10.1111/aor.14812

39034871