Routine end-ischemic hypothermic oxygenated machine perfusion in liver transplantation from donors after brain death. A randomized controlled 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.

Markmann JF, Aboulijoud MS, Ghobrial RM, Bhati CS, Pelletier SJ, Lu AD et al.

JAMA Surg 2022; 157: 189-198.

Of 293 patients included, machine perfusion reduced the rate of early graft dysfunction (18 versus 31 per cent, P=0.01), and improved use of the liver from donors after cardiac death (51 versus 26 per cent, P=0.007).

Comment: Increasing evidence of the value of this technology.