Frequent Use of Machine Perfusion Enables Utilization of Higher-Risk DCD Livers in the United States: Are We There Yet?

We appreciate Matevish et al. [ 1 Matevish L.E. Vagefi P.A. Patel M.S. Trends in Current Use of Machine Perfusion for Donation after Cardiac Death Donors in the United States. J Hepatol. 2024 Apr 26; (S0168-8278(24)00286-1)https://doi.org/10.1016/j.jhep.2024.04.018 Abstract Full Text Full Text PDF Google Scholar ] for their insightful comments on our recent meta-analysis regarding machine perfusion (MP) in liver transplantation [ 2 Parente A. Tirotta F. Pini A. Eden J. Dondossola D. Manzia T.M. et al. Machine perfusion techniques for liver transplantation - A meta-analysis of the first seven randomized controlled trials. J Hepatol. 2023 Nov; 79: 1201-1213 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ]. In their analysis of the Scientific Registry of Transplant Recipients (SRTR), they examined the use of MP in donation after circulatory death (DCD) liver transplants in the United States (US). Their research demonstrated a significant increase in the use of MP for preserving DCD grafts over the past three years, now accounting for more than half of procurements [ 1 Matevish L.E. Vagefi P.A. Patel M.S. Trends in Current Use of Machine Perfusion for Donation after Cardiac Death Donors in the United States. J Hepatol. 2024 Apr 26; (S0168-8278(24)00286-1)https://doi.org/10.1016/j.jhep.2024.04.018 Abstract Full Text Full Text PDF Google Scholar ]. This notable shift occurred primarily after the Food and Drug Administration (FDA) approved two normothermic machine perfusion (NMP) devices for clinical use: the Organ Care System (OCS™) Liver (TransMedics, Andover, MA) in September 2021 and OrganOx (OrganOx metra®, Oxford, United Kingdom) in December 2021. Since then, the number of liver grafts preserved with MP has sharply risen in the US, particularly for DCD livers [ 1 Matevish L.E. Vagefi P.A. Patel M.S. Trends in Current Use of Machine Perfusion for Donation after Cardiac Death Donors in the United States. J Hepatol. 2024 Apr 26; (S0168-8278(24)00286-1)https://doi.org/10.1016/j.jhep.2024.04.018 Abstract Full Text Full Text PDF Google Scholar ]. Despite these trends, currently available analyses do not demonstrate the benefits of NMP for DCD grafts in terms of graft loss or retransplantation rates yet [ 2 Parente A. Tirotta F. Pini A. Eden J. Dondossola D. Manzia T.M. et al. Machine perfusion techniques for liver transplantation - A meta-analysis of the first seven randomized controlled trials. J Hepatol. 2023 Nov; 79: 1201-1213 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ]. This is due to several factors, including inconsistent risk and outcome reporting and the limited number of risk-matched comparative analyses between machine perfusion (MP) and cold storage DCD liver preservation. Trends in Current Use of Machine Perfusion for Donation after Cardiac Death Donors in the United StatesJournal of HepatologyPreviewThe recent meta-analysis of machine-perfusion techniques for liver transplant by Parente et al.1 provides a much-awaited comprehensive assessment of the current literature on machine perfusion compared to static cold storage. With the promise of optimizing marginal and extended criteria grafts, and minimizing their risk of ischemic reperfusion injury, the transplant community has seen a progressive adoption of various perfusion strategies in the last several years. However, the landscape remains in flux regarding its optimal role and indications. Full-Text PDF Machine perfusion techniques for liver transplantation - A meta-analysis of the first seven randomized-controlled trialsJournal of HepatologyVol. 79Issue 5PreviewMachine perfusion is increasingly being tested in clinical transplantation. Despite this, the number of large prospective clinical trials remains limited. The aim of this study was to compare the impact of machine perfusion vs. static cold storage (SCS) on outcomes after liver transplantation. Full-Text PDF