Abdominal normothermic regional perfusion is associated with improved graft survival in liver transplantation from circulatory death donors

This is the authors' abstract. We don't add key points for this paper.

Advanced preservation strategies are increasingly used in liver transplantation following donation after circulatory death (DCD). This nationwide observational study evaluated the association between abdominal normothermic regional perfusion (A-NRP) and 1-year graft survival in a Swiss cohort of 254 DCD liver transplants performed between 2017 and 2023. Recovery strategies compared included A-NRP and super-rapid recovery (SRR), both predominantly followed by end-ischemic hypothermic oxygenated perfusion (HOPE). Primary endpoint was 1-year graft loss; secondary endpoints included 1-year patient mortality, primary non-function, non-anastomotic strictures (NAS), biliary and vascular complications and need for re-transplantation. Overall, 53 grafts were retrieved using A-NRP (71% followed by HOPE) and 201 using SRR (90% followed by HOPE). Compared with SRR, A-NRP grafts demonstrated lower rates of graft loss (5.7% vs. 24.6%), 1-year mortality (1.9% vs. 13.3%), NAS (5.7% vs. 20.5%), other biliary complications (1.9% vs. 12.6%) and re-transplantation (3.8% vs. 12.8%). In multivariable Cox regression analysis, A-NRP was associated with lower risk of 1-year graft loss and patient mortality after adjustment for UK DCD risk category and HOPE use. These findings suggest that A-NRP is associated with improved outcomes. Further studies are needed to define the role of ex-situ perfusion after A-NRP in optimizing results.