Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time.

Background: Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).

Methods: This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.

Results: Among 68 DCD LT with tDWIT ≥ 30, 64.7% (n = 44) were preserved with NMP and 35.3% (n = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (p < 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, p < 0.01) and IC (2.3% vs. 29.2%, p < 0.01). One-year graft survival was higher in NMP (p < 0.01), and 1-year patient survival was comparable between groups (p = 0.18).

Conclusions: NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.