A portable hypothermic oxygenated machine perfusion strategy initiated by an organ procurement organization may have enabled successful liver transplantation using medically complex and higher-risk donor organs, with 100% patient and graft survival at a median follow-up of 449 days in a US series.
In the study, researchers retrospectively evaluated 18 patients who underwent liver transplantation using liver allografts recovered and perfused by a regional organ procurement organization between November 2023 and July 2025. The protocol used portable hypothermic oxygenated machine perfusion (HMP-O2) initiated at the donor hospital by organ procurement organization staff who were trained to use and cannulate the liver allografts.
Among the donors, 67% (n = 12) of them were donation-after-circulatory-death donors. The median donor age was 59.5 years, and the median body mass index was 27 kg/m2. The median time from cross-clamp to HMP-O2 initiation was 105 minutes, with a median total perfusion duration of 443.5 minutes and cold ischemia time of 582 minutes. Further, 39% (n = 7) of the grafts were accepted following late preoperative or post–cross-clamp declines, and 50% (n = 9) of them were allocated out of sequence.
Early posttransplant events were limited. One patient each developed the following adverse events: early bile leak, anastomotic biliary stricture, early allograft dysfunction, and acute cellular rejection. No cases of ischemic cholangiopathy or primary nonfunction were observed.
The researchers highlighted that the outcomes were similar across donor types. Among the patients receiving donation after circulatory death livers, early allograft dysfunction occurred in one patient, bile leak in one patient, and unplanned reoperation in two patients. No vascular complications, biliary strictures, or ischemic cholangiopathy occurred in this subgroup.
In a propensity-matched comparison with transplant center–initiated HMP-O2, preservation times were longer in the organ procurement organization group, with a median cold ischemia time of 9.7 vs 7.1 hours and a perfusion duration of 7.4 vs 4.5 hours. Despite this, posttransplant outcomes, including early allograft dysfunction, biliary complications, and 6-month survival, were similar between the groups.
No technical failures of cannulation or cannulation-related vascular injuries were reported during implementation.
The study was limited by its small sample size, single-center design, and logistic considerations related to training and device transport.
“[I]mplementation and adoption of organ procurement organization–initiated portable machine perfusion strategy with local donor recovery for liver transplantation is possible,” concluded lead study author Christine E. Haugen, MD, PhD, of the Division of Transplant in the Department of Surgery at the University of Cincinnati School of Medicine, and colleagues.
The study was funded by Organ Recovery Systems. Co–study author James V. Guarrera, MD, and senior study author Ralph C. Quillin III, MD, reported consulting relationships with Organ Recovery Systems. The study authors reported no other conflicts of interest.
Source: Surgery
