Ischemia-free Liver Transplantation: 7-y Experience From a Single-center Cohort in China

Background. Ischemia-free liver transplantation (IFLT) is a novel approach designed to completely eliminate ischemia/reperfusion injury, whereas normothermic machine perfusion (NMP) unavoidably exposes grafts to ischemia/reperfusion injury. The study aims to evaluate postoperative complications and patient survival in IFLT compared with NMP. Methods. In this single-center retrospective cohort study, we analyzed 220 recipients with donation after brain death liver transplantation between 2017 and 2024. Propensity score matching was used for matching in a 1:1 ratio between the IFLT group and the NMP group. The primary endpoint was early allograft dysfunction (EAD), with secondary endpoints including postoperative complications, comprehensive complication index (CCI), and patient survival. Results. After propensity score matching, there were 72 patients who received IFLT and 72 who received NMP. The incidence of EAD (15.30% versus 44.40%, P < 0.001) and the CCI at 1 y posttransplant (26.74 [95% confidence interval, 20.87-32.61] versus 38.67 [95% confidence interval, 30.95-46.39], P = 0.039) in IFLT were significantly lower than in NMP. There was a higher 1-y posttransplant patients survival rate (95.57% versus 86.11%) and graft survival rate (95.57% versus 86.11%) in the IFLT group. The overall patient survival rate was significantly higher in the IFLT group than in the NMP group (hazard ratio, 0.2731; log-rank P = 0.0084). Among extended criteria donor recipients, IFLT demonstrated superior outcomes compared with NMP, with a significantly lower incidence of EAD, reduced CCI at 1 y posttransplant, and improved 1-y posttransplant patient survival. Conclusions. Among patients with end-stage liver diseases, IFLT significantly reduced EAD and improved 1-y posttransplant patient survival compared with NMP.