A randomized trial of normothermic preservation in liver transplantation

Nature. 2018 May;557(7703):50-56. doi: 10.1038/s41586-018-0047-9. Epub 2018 Apr 18.


Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Allografts / pathology
  • Allografts / physiology*
  • Allografts / physiopathology
  • Allografts / standards
  • Bile Ducts / pathology
  • Bile Ducts / physiology
  • Bile Ducts / physiopathology
  • Female
  • Graft Survival
  • Humans
  • Length of Stay
  • Liver / enzymology
  • Liver / physiology*
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Organ Preservation / adverse effects
  • Organ Preservation / methods*
  • Perfusion
  • Survival Analysis
  • Temperature*
  • Tissue Donors / supply & distribution
  • Tissue and Organ Harvesting / adverse effects
  • Tissue and Organ Harvesting / methods*
  • Treatment Outcome
  • Waiting Lists
  • Young Adult