Clinical Implementation of Prolonged Liver Preservation and Monitoring Through Normothermic Machine Perfusion in Liver Transplantation.

Cardini, Benno; Oberhuber, Rupert; Fodor, Margot; Hautz, Theresa; Margreiter, Christian; Resch, Thomas; Scheidl, Stefan; Maglione, Manuel; Bösmüller, Claudia; Mair, Harald; Frank, Marion; Augustin, Florian; Griesmacher, Andrea; Schennach, Harald; Martini, Judith; Breitkopf, Robert; Eschertzhuber, Stephan; Pajk, Werner; Obwegeser, Alois; Tilg, Herbert; Watson, Christopher; Öfner, Dietmar; Weissenbacher, Annemarie; Schneeberger, Stefan

BACKGROUND Normothermic machine perfusion (NMP) bears the potential for significant prolongation of liver preservation prior to transplantation. Although safety and feasibility have been recently published, not data are available describing the significant challenges of establishing NMP programs outside clinical studies. We herein present our experience and propose a multidisciplinary approach for liver NMP in the clinical routine. METHODS AND RESULTS In February 2018, liver NMP was introduced for routine use in marginal organs, logistical challenges and complex recipients at our institution. In a multidisciplinary effort between transplant coordinators, perfusionists, transplant surgeons, anesthesia, nurses, blood bank as well as laboratory staff, a clinical routine was established and 34 NMP cases were performed without critical incidents or organ loss. Nine livers were discarded due to poor organ quality and function observed during NMP. Twenty-five livers were successfully transplanted after preservation of up to 38 hours. The ECD rate was 100% and 92% in discarded and transplanted livers. Nighttime procedures and parallel transplantations were eventually omitted. Graft and patient survival was 88% at 20 months. No cholangiopathy was observed despite the use of extended criteria donor organs in 92% of cases. CONCLUSION NMP in a multidisciplinary approach enables a safe prolongation of liver preservation and overnight organ care. A first field test of NMP indicates safety and benefit of this approach.