Archie WH, Baimas-George M, Haynes N, Kundu S, Peterson K, Wehrle CJ, Huckleberry D, Eskind L, Levi D, Soto JR, Denny R, Casingal V, Cochran A, Rein EH, Vrochides D. Upper limit of normothermic machine preservation of liver grafts from donation after circulatory death yet to be defined. World J Transplant 2025; 15(2): 99170 [DOI: 10.5500/wjt.v15.i2.99170]
Corresponding Author of This Article
William H Archie, MD, Doctor, Division of Adominal Transplant, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, United States. william.archie@atriumhealth.org
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2025; 15(2): 99170 Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.99170
Upper limit of normothermic machine preservation of liver grafts from donation after circulatory death yet to be defined
William H Archie, Maria Baimas-George, Nathanael Haynes, Souma Kundu, Katheryn Peterson, Chase J Wehrle, Damien Huckleberry, Lon Eskind, David Levi, Jose R Soto, Roger Denny, Vincent Casingal, Allyson Cochran, Erin H Rein, Dionisios Vrochides
William H Archie, Maria Baimas-George, Nathanael Haynes, Souma Kundu, Katheryn Peterson, Damien Huckleberry, Lon Eskind, David Levi, Jose R Soto, Roger Denny, Vincent Casingal, Erin H Rein, Dionisios Vrochides, Division of Adominal Transplant, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, United States
Chase J Wehrle, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Transplant Research Center, Cleveland, OH 44195, United States
Allyson Cochran, Department of Surgery, Carolinas Center for Surgical Outcomes Science, Carolinas Medical Center, Charlotte, NC 28203, United States
Author contributions: Archie WH, Baimas-George M, Haynes N and Kundu S assisted with literature review and manuscript writing; Peterson K assisted with data abstraction and analysis; Wehrle CJ assisted with study design and data analysis; Huckleberry D, Eskind L, Levi D, Soto JR, Denny R, Casingal V, and Rein EH assisted with data collection, particularly perfusion parameters and donor information; Cochran A performed statistical analysis of all collected data; Vrochides D was the principal investigator assisting in project design, data interpretation and final manuscript writing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This project was approved by the Institutional Review Board (IRB00097121).
Informed consent statement: Full waiver of consent was obtained.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: Our data contains protected health information. Deidentified data can be made available upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: William H Archie, MD, Doctor, Division of Adominal Transplant, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, United States. william.archie@atriumhealth.org
Received: July 15, 2024 Revised: November 7, 2024 Accepted: December 11, 2024 Published online: June 18, 2025 Processing time: 220 Days and 20 Hours
Abstract
BACKGROUND
The normothermic machine perfusion pump (NMPP) could shape the future of transplantation. Providing ex-vivo optimization, NMPP attenuates ischemic insult while replenishing energy. An understanding of machine perfusion time (MPT) impact and potential clinical benefits is paramount and necessitates exploration.
AIM
To investigate the relationship between MPT and post-transplant graft function.
METHODS
Retrospective review of the first 50 donation after circulatory death (DCD) grafts preserved using NMPP in a tertiary institution was performed. Essential preservation time points, graft parameters, recipient information, and postoperative outcomes were prospectively recorded. Early allograft dysfunction (EAD), L-Graft7 score and 90-day outcomes were collected for all grafts. The first 20 recipients were allocated into the early group, considered the learning curve population for the center. The subsequent 30 were allocated into the late group. Recipients were also stratified into cohorts depending on MPT, i.e., short (< 8 hours), medium (8-16 hours) and long (> 16 hours).
RESULTS
NMPP operational parameters were not predictive of EAD, L-GrAFT7 or 90-day outcomes. The early group had significantly less MPT and cold ischemia time than the late group (553 minutes vs 850 minutes, P < 0.001) and (127.5 minutes vs 154 minutes, P = 0.025), respectively. MPT had no impact in either group.
CONCLUSION
Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population, indicating its upper limits, likely beyond 24 hours, are not demonstrated within this study. Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and, if the latter, what is the maximum safe duration. Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.
Core Tip: We performed a retrospective study of the first 50 liver transplants at a single-center tertiary institution to determine if there was any observed relationship between machine perfusion time (MPT) and post-transplant graft function for liver grafts from donation after circulatory death (DCD) and found there to be none despite MPT ranging from six up to 24 hours. This leads us to conclude that the pump itself, not duration, provides the benefit to the graft and that we have yet to determine the upper time limit for maintaining DCD livers on pump, if one exists.
