Normothermic machine perfusion for older transplant recipients

Author:

Shubin Andrew D.1ORCID,Feizpour Cyrus A.1,Hwang Christine S.1,Hanish Steven I.1,Raschzok Nathanael2,Wang Benjamin K.1,Desai Dev M.1,Shah Jigesh A.1,Vagefi Parsia A.1,MacConmara Malcolm P.3,Patel Madhukar S.1ORCID

Affiliation:

1. Department of Surgery, Transplant Division University of Texas Southwestern Medical Center Dallas Texas USA

2. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery, Experimental Surgery Berlin Germany

3. Transmedics Inc 200 Minutemen Rd Andover Massachusetts 01810 USA

Abstract

AbstractIntroductionElderly patients (≥65 years old) are increasingly undergoing liver transplantation and are more likely to be removed from the waitlist. Normothermic machine perfusion (NMP) holds promise in expanding the number of livers available for transplant and improving outcomes for marginal donors and recipients. We aimed to determine the impact of NMP on outcomes in elderly recipients at our institution and nationally using the UNOS database.MethodsThe use of NMP on outcomes in elderly recipients was reviewed using both the UNOS/SRTR database (2016–2022) and institutional data (2018–2020). Characteristics and clinical outcomes were compared between the NMP and static cold (control) groups within both populations.ResultsNationally, using the UNOS/SRTR database, we identified 165 elderly recipients from 28 centers who received a liver allograft undergoing NMP and 4270 that underwent traditional cold static storage. NMP donors were older (48.3 vs. 43.4 years, p < 0.01), had similar rates of steatosis (8.5% vs 8.5%, p = 0.58), were more likely to be from a DCD (41.8% vs 12.3%, p < 0.01), and had a higher donor risk index (DRI; 1.70 vs. 1.60, p < 0.02). NMP recipients had similar age but had a lower MELD score at transplant (17.9 vs. 20.7, p = 0.01). Despite increased marginality of the donor graft, NMP recipients had similar allograft survival and decreased length of stay, even after accounting for recipient characteristics including MELD. Institutional data showed that 10 elderly recipients underwent NMP and 68 underwent cold static storage. At our institution, NMP recipients had a similar length of stay, rates of complications, and readmissions.ConclusionsNMP may mitigate donor risk factors that are relative contraindications for transplantation in elderly liver recipients, increasing the donor pool. The application of NMP in older recipients should be considered.

Publisher

Wiley

Subject

Biomedical Engineering,General Medicine,Biomaterials,Medicine (miscellaneous),Bioengineering

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