Background: Donation after circulatory death (DCD) allografts were not widely used in liver transplantation (LT) due to higher rates of biliary complications and re-transplantation. While European trials have shown improvement in early allograft function and biliary complications with hypothermic oxygenated machine perfusion (HMP-O2) compared with traditional static cold storage (SCS) on ice, no US clinical series have demonstrated a benefit. Study Design: All DCD LTs performed at a single center from 4/6/2015-12/24/2024 were evaluated. DCD HMP-O2 transplants were performed under a clinical trial (NCT03484455 & NCT05574361). Six-month outcomes were compared between those preserved with SCS (n=47) vs HMP-O2 (n=62). Results: Among 109 DCD LT recipients, the median age was 61 years, 29.4% were female, with BMI of 29.6 kg/m 2 and MELD score of 16. DCD-HMP-O2 donors were older (51 vs. 37 years, p<0.001), had longer functional warm ischemia time (23 vs. 18 minutes, p<0.001), higher UK-DCD risk scores (8 vs. 3,p<0.001), and longer preservation times (9.1 vs. 4.7 hours,p<0.001). DCD-HMP-O2 recipients had lower incidence of primary non-function (0.0% vs. 6.4%, p=0.04), non-anastomotic biliary strictures (1.6% vs. 14.9%, p=0.008), and ischemic cholangiopathy (1.6% vs. 10.6%, p=0.04) compared with DCD-SCS recipients. After adjustment, HMP-O2 use was associated with 97% lower odds of ischemic cholangiopathy (aOR:0.03, 95%CI:0.01-0.71,p=0.03) compared with SCS. Conclusions: In this first US study of HMP-O2 use in DCD LT, HMP-O2 decreased primary non-function and biliary complications compared with SCS, despite the use of higher risk DCD allografts. With the exponential rise in DCD use, HMP-O2 can improve clinical outcomes for these recipients.
Haugen et al. (Wed,) studied this question.