Baimas-George M, Archie WH, Soltys K, Soto JR, Levi D, Eskind L, Casingal V, Denny R, Attia M, Mazariegos GV, Vrochides D. Optimizing liver utilization for transplantation with partial grafts undergoing normothermic machine perfusion: Two case reports. World J Transplant 2025; 15(3): 104109 [DOI: 10.5500/wjt.v15.i3.104109]
Corresponding Author of This Article
Dionisios Vrochides, MD, PhD, Professor, Division of Abdominal Transplantation, Department of Surgery, Carolinas Medical Center, 1021 Morehead Medical Dr Suite 50200, Charlotte, NC 28203, United States. dionisios.vrochides@atriumhealth.org
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
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. Sep 18, 2025; 15(3): 104109 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.104109
Optimizing liver utilization for transplantation with partial grafts undergoing normothermic machine perfusion: Two case reports
Maria Baimas-George, William H Archie, Kyle Soltys, Jose R Soto, David Levi, Lon Eskind, Vincent Casingal, Roger Denny, Magdy Attia, George V Mazariegos, Dionisios Vrochides
Maria Baimas-George, William H Archie, Jose R Soto, David Levi, Lon Eskind, Vincent Casingal, Roger Denny, Dionisios Vrochides, Division of Abdominal Transplantation, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, United States
Kyle Soltys, George V Mazariegos, Division of Pediatric Abdominal Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Magdy Attia, Liver Transplant Unit, Leeds Teaching Hospital, Leeds BD 11, United Kingdom
Author contributions: Baimas-George M, Soltys K, Levi D, Eskind L, Casingal V, Mazariegos GV, and Vrochides D designed the study, performed the research, analyzed the data, and wrote the manuscript; Archie W, Soto JR, Denny R, and Attia M performed the research and wrote the manuscript; all authors read and approved the final manuscript. Baimas-George M illustrated Figure 1.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Dionisios Vrochides, MD, PhD, Professor, Division of Abdominal Transplantation, Department of Surgery, Carolinas Medical Center, 1021 Morehead Medical Dr Suite 50200, Charlotte, NC 28203, United States. dionisios.vrochides@atriumhealth.org
Received: December 10, 2024 Revised: December 30, 2024 Accepted: February 10, 2025 Published online: September 18, 2025 Processing time: 129 Days and 14.5 Hours
Abstract
BACKGROUND
Liver transplantation (LT) is the only curative, life-saving option for children and adults with end-stage liver disease. Due to the well-known shortage and heterogeneity of grafts, split LT (SLT) is an attractive strategy to expand the donor pool and reduce waitlist times. Given increased risk of cold ischemia time with SLT, machine perfusion represents a promising option to reduce it and optimize transplant logistics and outcomes. The present communication describes various possible combinations of procurement steps to perform SLT facilitated by placing one or both grafts on a normothermic machine perfusion (NMP) closed circuit device.
CASE SUMMARY
A 19-month-old female with biliary atresia after failed Kasai portoenterostomy and a 42-year-old woman with unresectable intrahepatic cholangiocarcinoma were selected as recipients for a SLT from a 17-year-old male donor. The SLT generated a left lateral segment and a right trisectional graft of appropriate volume for both recipients. After a mixed in-situ and ex-situ split, in order to improve logistics, the right trisectional graft was placed on a closed circuit NMP device, following an appropriate vascular reconstruction. Both grafts were implanted with excellent short-term outcomes.
CONCLUSION
Use of NMP with SLT for preservation prior to implantation allows not only for graft optimization but also for significant improvement of transplant logistics. We propose various models and standardization of logistic options for combining SLT with NMP to optimize graft availability and outcomes.
Core Tip: Due to the well-known shortage and heterogeneity of grafts, split liver transplantation (SLT) is an attractive strategy to expand the donor pool and reduce waitlist times. Given increased risk of cold ischemia time, machine perfusion represents a promising option to optimize transplant logistics and outcomes. This article proposes various models and standardization of logistic options for combining SLT with normothermic machine perfusion to optimize graft availability and outcomes.
