Liver Transplant Outcomes Impacted by Normothermic Storage of Donor Organ

liver transplant
liver transplant
Investigators assessed the effects of portable normothermic perfusion liver preservation vs ischemic cold storage on outcomes of liver transplantation.

The outcomes of liver transplant may improve when the donor organ is preserved using portable normothermic perfusion instead of ischemic cold storage (ICS), according to a study published in JAMA Surgery.

This multicenter trial included 293 patients who were randomly assigned 1:1 to receive a liver that had been preserved using ICS or the Organ Care System (OCS) Liver method ( Identifier: NCT02522871). ICS is standard of care while OCS Liver preserves the liver in a metabolically active condition using normothermic blood perfusion.

The primary outcome assessed the incidence of early allograft dysfunction. Secondary outcomes included patient survival at 30 days and the incidence of ischemic biliary complications.

In total, 151 patients were included in the OCS Liver group and 142 in the ICS group. Transplant recipient demographic characteristics were comparable between groups. Mean patient age in the OCS Liver group was 57.2 (SD, 10.3) years vs 58.4 (SD, 0.1) years in the ICS group. Thirty-four percent and 31% of recipients were women in the OCS Liver and ICS groups, respectively.

Transplant livers preserved with OCS Liver had a significant decrease in the incidence of early allograft dysfunction compared with ICS-preserved livers (27 of 151 [18%] vs 44 of 142 [31%]; P =.01). The OCS Liver group also had a significant decrease in the incidence of ischemic biliary complications at 6 months (2 of 151 [1.3%] vs 12 of 142 [8.5%]; P =.02). Patient survival was comparable between the 2 groups.

Mean number of liver graft-related severe adverse events within 30 days post-transplant in the OCS Liver group was noninferior to that of the ICS group (P <.001).

This study was limited by incomplete blinding of the transplant teams to the method of liver preservation. 

Given the limitations of ICS, the improved post-transplant outcomes associated with the use of the OCS Liver may change the standard of care in donor liver preservation. “The advent of portable, extracorporeal, donor liver machine perfusion offers for the first time a convenient and effective approach to both assess and enhance donor liver function, thereby improving transplant safety, expanding the liver donor pool, and reducing waiting list mortality,” investigators concluded.

Disclosure: The authors declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of author disclosures.


Markmann J, Abouljoud S, Ghobrial M, et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS liver PROTECT randomized clinical trial. JAMA Surg. Published online January 05, 2022. doi:10.1001/jamasurg.2021.6781