Effect of Hepatic Arterial Reconstruction prior to On-Site Normothermic Machine Perfusion in Donation after Circulatory Death Liver Transplant.

Objectives: On-site normothermic machine perfusion of the liver may require hepatic arterial reconstruction. The effect of arterial reconstruction on the deve-lopment of primary ischemic cholangiopathy has not been fully elucidated in liver transplants with organs donated after circulatory death. The aim of this study was to evaluate the effect of normothermic machine perfusion with arterial reconstruction at the onset of ischemic cholangiopathy in liver transplants with organs donated after circulatory death.

Materials and methods: We retrospectively reviewed 93 patients who had received liver transplants donated after circulatory death for the period from 2015 to 2023 at a single institution. The primary endpoint was the onset of primary ischemic cholangiopathy within 1 year after donation after circulatory death liver transplant, excluding secondary ischemic cholangiopathy due to arterial complications.

Results: Normothermic machine perfusion was used for 71 cases, whereas standard cold storage was applied for 22 cases. Arterial reconstruction was performed in 14.1% of cases versus 27.3% of cases without normothermic machine perfusion. The cumulative onset of ischemic cholangiopathy was 7.0% versus 27.2% without normothermic machine perfusion (P = .013). In the group with normothermic machine perfusion, competing risk analyses demonstrated that the cumulative ischemic cholangiopathy onset rate was significantly higher in the group with arterial reconstruction (30.0%) versus without arterial reconstruction (3.3%) (P < .003). Total cold ischemia time and cold ischemia time between liver recovery and normothermic machine perfusion initiation were significantly longer in the group with arterial reconstruction (P < .001), without significant differences in arterial flow on normothermic machine perfusion and other relevant factors.

Conclusions: In donation after circulatory death liver transplant recipients with normothermic machine perfusion, arterial reconstruction is a risk factor for developing ischemic cholangiopathy, likely mediated by cold ischemia time prolongation.