Upper limit of normothermic machine preservation of liver grafts from donation after circulatory death yet to be defined

Table 1 Post-transplant laboratories between post-operative day one and post-operative day seven

Postoperative laboratories	POD1	POD2	POD3	POD4	POD5	POD6	POD7
Total bilirubin (mg/dL)	4.50	3.40	3.30	3.22	3.07	3.09	3.08
Direct bilirubin (mg/dL)	2.80	2.10	2.00	1.91	1.82	1.87	1.78
Aspartate aminotransferase (IU/L)	497.10	251.45	102.63	60.14	47.84	40.86	42.30
Alanine aminotransferase (IU/L)	260.57	248.76	185.96	153.47	125.45	109.10	104.72
International normalized ratio	1.46	1.36	1.33	1.33	1.32	1.32	1.30
Lactate (mmol/L)	1.57	-	-	-	-	-	-
Platelets (10e3/uL)	68.61	65.02	63.55	68.76	71.86	83.84	99.91
Creatinine (mg/dL)	5.98	2.34	4.19	2.10	2.00	1.99	2.00

Reported as mean value for study population. POD: Postoperative day.

Table 2 Descriptive statistics of recipients and normothermic machine perfusion pump parameters

Recipient descriptors	n	Median	Range
Age (years)	50	59	33-72
Transplant model for end-stage liver disease	49	26	7-39
Graft descriptors
L-Graft7	50	4.3	1.9-44.0
Donor risk index	50	1.632	1.339-2.735
Preservation descriptors
Machine perfusion time (minutes)	49	660	223-1446
Cold ischemia time (minutes)	48	146	45-241
Warm ischemia time (minutes)	50	29	8-132

Values listed as median and range.

Table 3 Univariate analysis of recipients and normothermia machine perfusion pump parameters

Recipient and graft descriptors	Beta coefficient	P value
Age (years)	0.012	0.931
Transplant model for end-stage liver disease	0.086	0.627
Time on pump (minutes)	0.005	0.217
Cold ischemia time (minutes)	0.013	0.658
Warm ischemia time (minutes)	-0.036	0.412
< 8 hours	-2.6	0.362
Late group	-1.1	0.667
Machine perfusion time groups
< 8 hours	Reference
8-16 hours	2.1	0.488
16-24 hours	4.1	0.279

Table 4 Comparative analysis of L-GrAFT₇, recipient and normothermic machine perfusion pump parameters across machine perfusion time groups, n (%)

Recipient and graft descriptors	< 8 hours (n = 12)	8-16 hours (n = 27)	16-24 hours (n = 10)	P value
LOS (days)	10 (6-42)	9 (6-24)	8 (6-38)	0.363
ICU LOS (days)	3.92 (2.21-25.47)	3.16 (0.16-9.15)	3.12 (0.71-8.08)	0.428
ICU readmission	0 (0)	2 (7.4)	4 (40)	0.009
Age (years)	62.5 (48-72)	57 (33-68)	59 (43-70)	0.227
Transplant model for end-stage liver disease	26.5 (13-39)	25 (7-34)	24 (7-30)	0.890
Machine perfusion time (minutes)	337 (223-458)	722 (510-920)	1154 (995-1446)	0.001
L-GrAFT7	3.9 (1.9-20.1)	5.5 (2-42.8)	4.8 (2.1-44.0)	0.312
Early allograft dysfunction	1 (8.33)	2 (7.41)	1 (8.33)	0.992
Donor risk index	1.62 (1.38-2.03)	1.63 (1.28-2.74)	1.71 (1.34-2.49)	0.670
Cold ischemia time (minutes)	135 (80-219)	153.5 (45-210)	140.5 (94-241)	0.719
Warm ischemia time (minutes)	28 (18-110)	29 (19-132)	29.5 (8-110)	0.970

All values except early allograft dysfunction (EAD) displayed as median (range). EAD displayed as count (percentage). LOS: Length of stay; ICU: Intensive care unit.

Table 5 Comparative analysis of L-GrAFT₇, recipient and normothermic machine perfusion pump parameters between ‘early’ and ‘late’ groups, n (%)

Recipient and graft descriptors	Early group (n = 20)	Late group (n = 30)	P value
LOS (days)	7.5 (6-42)	10 (6-38)	0.096
ICU LOS (days)	3.4 (0.16-25.5)	3.2 (0.48-10.5)	0.488
ICU Readmission	1 (5)	5 (16.7)	0.214
Age (years)	60.5 (33-72)	58.5 (42-72)	0.779
Transplant model for end-stage liver disease	27 (14-29)	25 (7-39)	0.574
Machine perfusion time (minutes)	553 (256-882)	850 (223-1446)	0.001
L-GrAFT7	3.9 (1.9-42.8)	4.9 (2-44)	0.641
Early allograft dysfunction	1 (5)	3 (10)	0.05
Donor risk index	1.63 (1.44-2.03)	1.63 (1.34-2.74)	0.694
Cold ischemia time (minutes)	127.5 (45-219)	154 (94-241)	0.025
Warm ischemia time (minutes)	29.5 (18-132)	29 (8-110)	0.871

All values except early allograft dysfunction (EAD) and intensive care unit (ICU) readmission displayed as median (range). EAD and ICU readmission displayed as count (percentage). LOS: Length of stay; ICU: Intensive care unit.

Table 6 Comparative analysis of normothermic machine perfusion pump parameters between grafts with and without backtable arterial reconstruction

Perfusion descriptors	No reconstruction (n = 39)	Reconstruction (n = 11)	P value
Machine perfusion time (minutes)	660 (223-1446)	707 (326-1183)	0.967
Cold ischemia time (minutes)	142 (45-241)	190.5 (129-219)	0.012
Warm ischemia time (minutes)	29 (8-132)	27 (12-98)	0.288

All values reported as median (range).

Table 7 Comparative analysis of 90-day outcomes between ‘early’ and ‘late’ groups, n (%)

90-day outcomes	Early group (n = 20)	Late group (n = 30)	P value
90-day endoscopic retrograde cholangiopancreatography	5 (25.0)	6 (20.0)	0.676
90-day graft loss	0	0	-
90-day mortality	2 (10.0)	0	0.077
90-day biliary complications	6 (30.0)	5 (16.7)	0.265
90-day hepatic artery thrombosis	0	0	-
90-day portal vein thrombosis	0	0	-

All values displayed as count (percentage).

Table 8 Comparative analysis of 90-day outcomes across machine perfusion time groups, n (%)

90-day outcomes	Less than 8 hours (n = 12)	8-16 hours (n = 27)	16-24 hours (n = 10)	P value
90-day endoscopic retrograde cholangiopancreatography	3 (25.0)	6 (22.2)	1 (10.0)	0.645
90-day graft loss	0	0	0	-
90-day mortality	1 (8.3)	1 (3.7)	0	0.610
90-day biliary complications	3 (25.0)	7 (25.9)	1 (10.0)	0.570
90-day hepatic artery thrombosis	0	0	0	-
90-day portal vein thrombosis	0	0	0	-