Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant. The OCS Liver PROTECT randomized clinical trial.

Kang M, Kim S, Choi JY, Kim KS, Jung YK, Park B et al. 

Br J Surg 2024; 111: znae102.

This meta-analysis of machine perfusion included 19 RCTs. The risk of delayed graft function was lowest after hypothermic machine perfusion: relative risk 0.77, 95 per cent confidence interval 0.69 to 0.86). Partial hypothermic perfusion was not effective.

Comment: Soon to be the standard of care?

Kumar M, Patil NS, Mohapatra N, Sindwani G, Dhingra U, Yadav A et al.
Ann Surg 2024; 279: 932-944.

A temporary shunt reduced intra-operative blood loss (P=0.004) and need for transfusion in this study of 60 procedures. The shunted patients were also more haemodynamically stable in the anhepatic phase, requiring less vasopressor support, with better postoperative renal function. There were no other differences in postoperative outcomes.

Comment: The observed advantages should improve outcomes, but perhaps the study was too small to be definitive.

Malinoski D, Saunders S, Swain S, Groat T, Wood PR, Reese J et al.

N Engl J Med 2023; 388: 418-426.

Some 1349 kidneys were transplanted from 725 deceased donors. Hypothermia was inferior to machine perfusion (or both) in terms of delayed graft function (30 versus 19 per cent), but after one year, graft survival rates were similar.

Comment: So the question is whether reduced delayed graft function is sufficient justification for machine perfusion.