Liver Transplantation After Ex-Vivo Normothermic Machine Perfusion: A No-Recooling Technique With Room-Temperature Albumin Flush

Normothermic machine perfusion (NMP) has emerged as a valuable preservation technique in liver transplantation, offering improved graft assessment and viability. Traditionally, liver grafts undergo a second cooling phase before implantation, which may contribute to cellular damage through ischemia-reperfusion injury. In this “How To Do It” article, we describe our surgical technique to avoid re-cooling following NMP. Specifically, after retrieval from the perfusion device, the graft is directly inserted into the surgical field and undergoes a standardized portal flush with 1 L of 5% albumin at room temperature before reperfusion. This method maintains physiological temperature, potentially reducing reperfusion stress and enhancing graft function. We detail step-by-step procedural aspects, including organ handling, vascular anastomoses, and intraoperative considerations, supported by our clinical outcomes.