Organ procurement organization utilization of portable hypothermic oxygenated machine perfusion in liver transplantation: The first US experience.

Abstract

Background: Advanced machine perfusion techniques have increased the use of hard-to-place organs, effectively changing the liver transplantation landscape. Liver transplantation machine perfusion has been driven largely by industry or individual transplant centers. We describe the implementation of a portable, organ procurement organization-initiated hypothermic oxygenated machine perfusion strategy for liver transplantation as a proof of concept.

Methods: Surgeons and staff at a regional organ procurement organization (Indiana Donor Network) were trained to use and cannulate liver allografts using a portable hypothermic oxygenated machine perfusion platform. We evaluated all liver transplantations recovered and placed on hypothermic oxygenated machine perfusion (N = 18) by the Indiana Donor Network for the University of Cincinnati from November 2023 to July 2025. Propensity score matching was used to match organ procurement organization-initiated hypothermic oxygenated machine perfusion cases with a control cohort.

Results: Among the 18 recipients, the median age was 57 years (50-63) with a Model for End-Stage Liver Disease score of 15.5 (13.5-21.5). Twelve (67.7%) were donation after circulatory death donors. Median time from cross-clamp to hypothermic oxygenated machine perfusion initiation was 105 minutes (84.3-118.5) and hypothermic oxygenated machine perfusion time was 443.5 minutes (293-530.3). One recipient developed an early bile leak, another developed an anastomotic biliary stricture, a third experienced early allograft dysfunction, and a fourth had acute cellular rejection. None of the recipients had ischemic cholangiopathy. Patient and graft survival were 100% at 449 days (274.5-570.5). Post-transplant outcomes and 6-month patient survival were comparable between the organ procurement organization-initiated hypothermic oxygenated machine perfusion and liver transplantation center-initiated hypothermic oxygenated machine perfusion recipients.

Conclusion: In the first reported US series describing organ procurement organization-initiated portable hypothermic oxygenated machine perfusion for liver transplantation, recipients experienced excellent outcomes with use of medically complex donors and long preservation times. This series demonstrates that implementation and adoption of organ procurement organization-initiated portable machine perfusion strategy with local donor recovery for liver transplantation is possible.