Normothermic Liver Machine Perfusion at a Large European Center: Real-world Outcomes following 238 Applications.

Objective: To report outcomes from routine clinical practice of liver transplantation (LT) following normothermic liver machine perfusion (NLMP) and compare to LT after static cold storage (SCS).

Background: NLMP is emerging as a clinical routine in LT and has recently received renewed attention; however, outcomes outside of clinical trials are lacking.

Methods: All adult LT between February 2018 and January 2023 were included. A comprehensive viability assessment was applied during NLMP. Outcomes were compared between NLMP and SCS recipients, as well as benchmark and non-benchmark cases.

Results: Of the 332 LT included, 174 underwent NLMP and 158 were transplanted after SCS. Sixty-seven organs were accepted and transplanted only under the premise of NLMP. One-year graft survival for SCS and NLMP recipients was 83.8% versus 81.3% and 93.4% for benchmark cases in the overall cohort. Total preservation time had no influence on graft survival in the NLMP group but was associated with inferior 1-year graft survival in the SCS group. NLMP usage increased significantly over the duration of the study period, as did the median total preservation time. With increasing NLMP use and longer preservation times, nighttime surgery decreased significantly from 41.9% to 4.2%.

Conclusions: Prolonged preservation times ease logistics and enable daytime surgery. The possibility of NLMP offers to expand LT without negatively affecting outcomes.