Machine perfusion has contributed to expanding the donor pool by altering the risk factors of Early Allograft Dysfunction in DCD liver transplantation

Document Type

Conference Proceeding

Publication Date

1-1-2026

Publication Title

Am J Transplant

Abstract

Background: Early allograft dysfunction (EAD) remains a known risk factor for poor patient survival in LT. This study aimed to investigate how the risk factors for EAD have changed with the advent of NMP. Method: Adult LT alone from DCD donor which were performed from 2016-2024 were evaluated. Patients were divided into two groups based on the use of NMP and logistic regression analysis was performed to identify risk factors associated with the development of EAD in each group. Result: This study included 193 adult DCD LT patients, 99 using NMP and 93 not using NMP. Donor age was significantly higher in the NMP group compared to the non-NMP group (45 years vs 38 years; p = 0.03). There was no significant difference in recipient age between the NMP group and the non-NMP group (59 years vs 58 years; p = 0.81). Steatosis was observed in 29% of the cases (n=56). There was no significant difference in the distribution of liver biopsy steatosis grades (<5%, 5-10%, >10%) between the NMP and non-NMP groups (p=0.34). In the non-NMP group, donor liver macrovascular steatosis (>=5%) was significantly associated with EAD, whereas in the NMP group this association was not significant (18.6%, p=0.01 vs 7.1%, p=0.12). Multivariable logistic regression model for EAD is shown in Table 1. In the non-NMP group, donor age, donor gender (male), Macrovascular steatosis(>=5%) were identified as a significant risk factor for EAD (OR 1.07, 95% CI 1.03-1.12, p=0.002, OR 3.26, 95% CI 2.14-9.31, p=0.03, OR 5.05, 95% CI 1.17-21.75, p=0.03). In contrast, in the NMP group, donor age, donor gender (male) and macrovascular steatosis(>=5%) were no longer a significant risk factor for EAD. Donor BMI was also identified as a significant risk factor for EAD. (OR 1.09, 95% CI 1.02-1.16, p=0.01). Conclusion: With NMP use, DCD donor age became significantly older. While donor age, donor gender (male) and macrovascular steatosis(>=5%) were considered a risk factor for EAD in non-NMP DCD LT, these factors were not a risk factor for EAD in NMP DCD LT. This indicating that NMP mitigates donor-related risks and contributes to expanding the donor pool without compromising post-transplant outcomes. However, the donor BMI is a risk factor for EAD in NMP. Therefore, these risk factors may need to be considered in DCD donor selection.

Volume

26

Issue

1

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