The current landscape of in situ and ex situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US

Anji Wall; Matthew Snoddy; Jinyu Du; Johanna Bayer; Sebastian Danobeitia; Seung Hee Lee; Eric Martinez; Amar Gupta; Gege Ran; William F Parker; Sumeet K Asrani; Giuliano Testa

doi:10.1016/j.ajt.2024.09.012

The current landscape of in situ and ex situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US

Am J Transplant. 2024 Sep 16:S1600-6135(24)00567-7. doi: 10.1016/j.ajt.2024.09.012. Online ahead of print.

Authors

Affiliations

¹ Division of Abdominal Transplantation, Department of Surgery, Baylor University Medical Center in Dallas, Dallas, Texas, USA. Electronic address: anji.wall@bswhealth.org.
² Division of Abdominal Transplantation, Department of Surgery, Baylor University Medical Center in Dallas, Dallas, Texas, USA.
³ Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
⁴ Department of Medicine, University of Chicago, Chicago, Illinois, USA.
⁵ Department of Medicine, Baylor University Medical Center in Dallas, Dallas, Texas, USA.

PMID: 39293517
DOI: 10.1016/j.ajt.2024.09.012

Abstract

Donation after circulatory death (DCD) is driving the increase in deceased organ donors in the United States. Normothermic regional perfusion (NRP) and ex situ machine perfusion (es-MP) have been instrumental in improving liver transplant outcomes and graft utilization. This study examines the current landscape of liver utilization from cardiac DCD donors in the United States. Using the United Network for Organ Sharing Standard Transplant Analysis and Research file, all adult (≥18 years old) DCD donors in the United States from which the heart was used for transplantation from October 1, 2020, to September 30, 2023, were compared by procurement technique (NRP versus super rapid recovery [SRR]) and storage strategy (es-MP versus static cold storage). One hundred eighty-eight livers were transplanted from 309 thoracoabdominal NRP donors (61% utilization) versus 305 (56%) liver transplants from 544 SRR donors. es-MP was used in 20% (n = 38) of NRP cases versus 32% (98) of SRR cases. Of the liver grafts, 281 (59%) were exposed to NRP, es-MP, or both. While there is widespread utilization of machine perfusion, more research is needed to determine optimal graft management strategies, particularly concerning the use of multiple technologies in complementary ways. More complete data collection is necessary at a national level to address these important research questions.

Keywords: donation after circulatory death; ex situ machine perfusion; liver transplantation; normothermic regional perfusion; organ procurement and allocation.