When Machine Perfusion Falls Short: Identifying Risks of Liver Graft Failure After Normothermic Machine Perfusion.
Liver grafts preserved with normothermic machine perfusion failed within one year in 8.1% of cases.
When Machine Perfusion Falls Short: Identifying Risks of Liver Graft Failure After Normothermic Machine Perfusion.
Machine perfusion technology has redefined donor and recipient criteria for liver transplantation.
The Organ Procurement and Transplantation Network database was used to retrospectively identify adult patients undergoing deceased donor liver transplantation with normothermic machine perfusion preservation between January 10, 2021, and December 31, 2024.
surgical or clinical complexity in the recipient drove failure more than graft quality
Regression analysis identified increased odds of graft failure with MELD score 35 (aOR 2.10 [1.21-3.63]), low recipient functional status (aOR 2.05 [1.31-3.21]), and prior abdominal surgery (aOR 1.33 [1.01-1.76]).
Alcohol-associated liver disease (aOR 0.36 [0.23-0.56]) was the only factor conferring a protective effect.
Centers with higher-than-expected standardized normothermic machine perfusion graft failure rates were higher-volume programs with low-risk case mixes; no centers had persistently high standardized failure rates throughout the study period.
Recipient factors, particularly those conferring surgical complexity, are more significantly associated with normothermic machine perfusion graft failure than donor factors.
Despite increased adoption of perfusion technologies to mitigate donor and operative risk, transplant provider clinical judgment remains critical for optimizing recipient-donor matching and outcomes.