Normothermia Machine Perfusion Is Associated With Reduced Transfusion Requirements, Improved Hemodynamic Stability, and Decreased Vasopressor Use During the Postreperfusion Phase of Liver Transplantation.

BACKGROUND

Normothermic machine perfusion (NMP) has emerged as a valuable preservation technique, expanding the donor pool and improving clinical outcomes in liver transplantation (LT). Despite its growing adoption and reported advantages, the perioperative impact of NMP remains incompletely defined. In this study, we aimed to investigate the effects of NMP versus static cold storage (SCS) on postreperfusion blood product utilization, hemodynamics, and vasopressor requirements.

METHODS

We conducted a retrospective cohort study of adult LT patients at our institution between January 2017 and November 2024. The NMP and SCS groups were matched using propensity scores generated from preoperative and prereperfusion variables.

RESULTS

A total of 1059 patients underwent LT, including 86 NMP and 973 SCS patients. Before matching, significant differences were noted in several preoperative and prereperfusion variables. After 1:3 propensity match, these differences were eliminated. Post-match analysis showed that the NMP group required significantly fewer transfusions (approximately 40% reduction observed across all blood products). NMP was also associated with significantly higher mean arterial pressure and reduced vasopressor requirements following reperfusion.

CONCLUSIONS

NMP was associated with reduced blood transfusion, improved hemodynamic stability, and decreased vasopressor support during the postreperfusion phase of LT.