Transplantation of Declined Liver Allografts Following Normothermic Ex-Situ Evaluation

Am J Transplant. 2016 Nov;16(11):3235-3245. doi: 10.1111/ajt.13875. Epub 2016 Jul 13.


The demand for liver transplantation (LT) exceeds supply, with rising waiting list mortality. Utilization of high-risk organs is low and a substantial number of procured livers are discarded. We report the first series of five transplants with rejected livers following viability assessment by normothermic machine perfusion of the liver (NMP-L). The evaluation protocol consisted of perfusate lactate, bile production, vascular flows, and liver appearance. All livers were exposed to a variable period of static cold storage prior to commencing NMP-L. Four organs were recovered from donors after circulatory death and rejected due to prolonged donor warm ischemic times; one liver from a brain-death donor was declined for high liver function tests (LFTs). The median (range) total graft preservation time was 798 (range 724-951) min. The transplant procedure was uneventful in every recipient, with immediate function in all grafts. The median in-hospital stay was 10 (range 6-14) days. At present, all recipients are well, with normalized LFTs at median follow-up of 7 (range 6-19) months. Viability assessment of high-risk grafts using NMP-L provides specific information on liver function and can permit their transplantation while minimizing the recipient risk of primary graft nonfunction. This novel approach may increase organ availability for LT.

Keywords: clinical research/practice; donors and donation: donor evaluation; donors and donation: extended criteria; liver allograft function/dysfunction; liver transplantation/hepatology; organ acceptance; organ perfusion and preservation; organ procurement and allocation.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Allografts
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control
  • Humans
  • Liver / blood supply
  • Liver / metabolism*
  • Liver Function Tests
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Organ Preservation*
  • Outcome Assessment, Health Care
  • Perfusion / methods*
  • Pilot Projects
  • Primary Graft Dysfunction / prevention & control
  • Tissue Donors / supply & distribution*
  • Tissue Survival*
  • Tissue and Organ Procurement / methods*
  • Warm Ischemia