Innovative magnetic anastomosis enables immediate liver transplantation without cold preservation

Living donor liver transplantation (LDLT) traditionally relies on static cold preservation, which may contribute to ischemia–reperfusion injury associated with abrupt temperature transitions. This study investigated the feasibility of immediate liver transplantation without cold storage using rapid magnetic anastomosis. Eighty-eight adult male Sprague–Dawley rats were randomly divided into two groups: Cold Storage Transplantation Group (CSTG) and Immediate Transplantation Group (ITG). Partial liver transplantation was performed using magnetic anastomosis, with the ITG group undergoing direct transplantation without cold preservation. Thermal imaging, histological analysis, oxidative stress markers, cellular proliferation, apoptosis, liver function, and inflammatory responses were evaluated at 1 and 5-days post-transplantation. The ITG demonstrated several key advantages: more stable temperature profiles during transplantation, significantly reduced oxidative stress during the ex vivo phase, enhanced hepatocyte proliferation and decreased cellular apoptosis ( P < 0.05 at day 5). Liver function markers showed improved recovery in the ITG, with significantly lower alanine aminotransferase (ALT) on day 5 ( P < 0.05 at day 5). The 14-day survival rates were comparable between groups (80% ITG vs. 70% CSTG, P = 0.629). Immediate liver transplantation using magnetic anastomosis appears feasible and may offer potential biological benefits, providing a novel approach that avoids conventional cold storage and warrants further investigation as a strategy for limiting preservation-related ischemic stress. This method demonstrated promising outcomes in terms of graft temperature stability, cellular proliferation, and reduced apoptosis, together with a lower serum ALT level on day 5. However, the delayed elevation of IL-1β and IL-6 and the incompletely defined mechanisms warrant further investigation. Further research in large animal models is warranted to validate these findings and evaluate the safety and translational potential of this approach.