Zhou Alice L, Akbar Armaan F, Ruck Jessica M, Weeks Sharon R, Wesson Russell, Ottmann Shane E, Philosophe Benjamin, Cameron Andrew M, Meier Raphael P H, King Elizabeth A
Division of Transplant Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Transplantation. 2025 Jun 1;109(6):967-975. doi: 10.1097/TP.0000000000005290. Epub 2024 Dec 26.
Machine perfusion (MP) for liver transplantation has become more widespread in the United States, but national studies on this growing practice are lacking. We investigated national use and outcomes of MP for liver transplantation.
Adult (≥18 y) liver recipients transplanted between January 1, 2016 and September 30, 2023 in the United Network for Organ Sharing database were included. We used Cox regression to compare 1-y posttransplant recipient survival and all-cause graft failure by use of MP and performed subgroup analyses among circulatory death (DCD) and brain death (DBD) donors.
Of 52 626 deceased donors with liver recovery, 1799 (3.5%) utilized MP. The proportion of all liver transplants using MP increased from 0.3% in 2016 to 15.5% in 2023. MP for DCD transplants increased from 0.8% in 2016 to 50.0% in 2023. Donors of MP grafts were older (47 [34-57] versus 42 [29-55] y, P < 0.001), had higher body mass indexes (28.3 [24.4-33.3] versus 27.3 [23.7-31.8] kg/m 2 , P < 0.001), and were more likely to be DCD (47.1% versus 9.3%, P < 0.001). Among DBD transplants, MP and non-MP DBD transplants had similar all-cause graft failure out to 1 y (adjusted hazards ratios, 1.12 [95% confidence interval, 0.87-1.43], P = 0.38). Among DCD transplants, MP recipients had improved survival out to 1 y (adjusted hazards ratios, 0.50 [95% confidence interval, 0.35-0.70], P < 0.001).
MP use in liver transplantation is rapidly expanding and is associated with favorable outcomes compared with cold storage. MP is associated with increased posttransplant survival for DCD transplants, highlighting the potential for MP to expand utilization of DCD grafts.
肝移植的机器灌注（MP）在美国已变得更加普遍，但缺乏关于这种不断发展的实践的全国性研究。我们调查了肝移植MP的全国使用情况和结果。
纳入2016年1月1日至2023年9月30日在器官共享联合网络数据库中接受移植的成年（≥18岁）肝移植受者。我们使用Cox回归比较使用MP和未使用MP的受者移植后1年的生存率和全因移植物失败情况，并在循环死亡（DCD）和脑死亡（DBD）供体中进行亚组分析。
在52626例有肝脏回收的已故供体中，1799例（3.5%）使用了MP。使用MP的肝移植比例从2016年的0.3%增加到2023年的15.5%。DCD移植中MP的使用从2016年的0.8%增加到2023年的50.0%。MP移植物的供体年龄更大（47[34 - 57]岁对42[29 - 55]岁，P < 0.001），体重指数更高（28.3[24.4 - 33.3]对27.3[23.7 - 31.8]kg/m²，P < 0.001），且更可能是DCD供体（47.1%对9.3%，P < 0.001）。在DBD移植中，MP和非MP的DBD移植在1年内全因移植物失败情况相似（调整后风险比，1.12[95%置信区间，0.87 - 1.43]，P = 0.38）。在DCD移植中，MP受者1年生存率有所提高（调整后风险比，0.50[95%置信区间，0.35 - 0.70]，P < 0.001）。
肝移植中MP的使用正在迅速扩大，与冷保存相比，其结果良好。MP与DCD移植后生存率提高相关，突出了MP扩大DCD移植物利用的潜力。
