Karishma Mistry, MD Creighton University, Omaha, NE
Introduction: Normothermic perfusion (NMP) is a new technique that has been introduced into transplantation expanding capacity for organ utilization. NMP has been shown to be an effective method of organ preservation specifically in potential donors after cardiac death by providing the opportunity for interventions in suboptimal organs. We hypothesized that outcomes were improved after NMP versus standard cold storage for liver organ preservation.
Methods: A systematic review of the literature on normothermic machine perfusion was conducted up until May 2023. We input key words like normothermic perfusion technique, organ transplantation, organ preservation, liver preservation techniques, and static cold storage (SCS) in PubMed as our search strategy and found a total of four papers reviewed without exclusions. Outcomes including graft survival, AST, hospital stay length, and graft injury were examined.
Results: All four studies examined graft survival, with some heterogeneity in results, although one observational trial supported improved outcomes from NMP. It also showed lower post-transplant AST levels for the NMP organs (417 vs 907) and longer graft survival. Another study examined was a randomized controlled trial (RCT) which showed 50% decrease in graft injury and 50% decrease in organ discard using NMP, although mean graft survival was in favor of SCS. This RCT also reported lower AST levels post-transplant favoring the NMP organs. In an additional observational study, NMP has also been shown to allow for potential enhancement of suboptimal livers prior to transplantation.
Discussion: Normothermic perfusion has hopes of making a dent in that gap in hopes of providing a larger liver donor pool that would not otherwise be possible with standard organ storage techniques due to its efficacy and organ optimization opportunities. NMP allows for the assessment of viability of grafts prior to transplant and can bring suboptimal grafts up to transplantation standards. While the data is limited, improved graft survival and AST levels are also noted for transplanted organs which underwent NMP. Furthermore, NMP can serve as a revolutionary platform for pharmacologic treatment of a graft for optimization depending on its specific needs. Further clinical studies are necessary to assess the clinical viability of NMP and all its beneficial uses, however current research demonstrates normothermic machine perfusion to be the superior technique in the world of liver transplantation.
Disclosures:
Karishma Mistry indicated no relevant financial relationships.
Karishma Mistry, MD. P2424 - Normothermic Machine Preservation: The New Standard for Liver Preservation?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
