Normothermic regional and ex situ perfusion reduces postreperfusion syndrome in donation after circulatory death liver transplantation: A retrospective comparative study.

In controlled donation after circulatory death (DCD) liver transplantation, ischemia-reperfusion injury is linked to postreperfusion syndrome (PRS), acute kidney injury (AKI), and early allograft dysfunction. Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) are techniques that mitigate ischemic injury and associated complications. In this single-center retrospective study, we compared early transplant outcomes of DCD livers undergoing direct procurement (DP) and static cold storage (SCS) (DCD-DP-SCS), NRP procurement with SCS (DCD-NRP-SCS), or DP with NMP (DCD-DP-NMP). Two hundred thirty-eight DCD liver recipients were evaluated, comprising 59 DCD-DP-SCS, 101 DCD-NRP-SCS, and 78 DCD-DP-NMP. Overall, the PRS incidence was 19%. DCD-DP-SCS had a higher incidence of PRS (37%; P < .001), AKI stage ≥2 (47%; P = .033), and an increased model for early allograft function score (P < .001). In adjusted multivariate analysis, recipient age (odds ratio [OR] 1.10, 95% CI 1.05-1.17; P < 0.001), and normothermic perfusion (DCD-NRP-SCS: OR 0.16, 95% CI 0.06-0.39; P < .001; DCD-DP-NMP: OR 0.38, 95% CI 0.15-0.91; P = .032) were significant predictors of PRS, which itself was associated with worse 5-year transplant survival (graft survival non-censored-to-death; Hazard ratio (HR) 2.9, 95% CI 1.3-6.7; P = .012). Compared to SCS alone, the use of either NRP or NMP significantly reduced the incidence of PRS and AKI with better early graft function.