A clinically deployed dual-compartment biochemical monitoring platform for human liver perfusion

The global shortage of transplantable donor livers increases reliance on marginal grafts, creating an urgent need for workflow-compatible assessment during normothermic machine perfusion. However, current biochemical evaluation remains constrained by intermittent perfusate sampling, low temporal resolution and limited cholangiobiliary context. Here we report a clinically deployed dual-compartment biochemical monitoring (DCBM) platform for human liver perfusion. The system integrates dual-channel microfluidics, multiplexed electrochemical sensing, bile-compatible antifouling interfaces and wireless data transmission to enable automated in-line measurement of pH, lactate and glucose in both perfusate and bile. In seven human donor livers, the DCBM platform shows strong agreement with standard laboratory assays while resolving transient biochemical excursions not captured by scheduled hourly sampling, including bile lactate elevations associated with subsequent adverse perfusion trends in selected cases. Continuous dual-compartment measurements further enable an exploratory outcome-anchored framework linked to post-transplant clinical course. This platform establishes a clinically deployed architecture for dual-compartment biochemical monitoring and provides an initial translational bridge from continuous sensing to viability-associated graft assessment during ex situ liver perfusion. Normothermic machine perfusion (NMP) enables near-physiological ex situ preservation and assessment of donor livers prior to transplantation. However, current practice relies on intermittent manual sampling of perfusate lactate, glucose, and pH, limiting real-time monitoring of dynamic changes. This study reports a dual-compartment biochemical monitoring platform that enables automated, inline measurement of lactate, glucose, and pH in both perfusate and bile, demonstrated through continuous monitoring during a pilot clinical deployment in seven human donor livers undergoing NMP.