Impact of advanced perfusion techniques in DCD and DBD liver transplantation

Results from a retrospective analysis of the Organ Procurement and Transplantation Network (OPTN)/Standard Transplant Analysis and Research (STAR) database, evaluating the impact of advanced perfusion techniques in donation after circulatory death (DCD; DCD + normothermic machine perfusion [NMP], n = 2,695; DCD + normothermic regional perfusion [NRP], n = 861; DCD + NRP + NMP, n = 645; DCD + static cold storage [SCS], n = 1,055) and donation after brain death (DBD; n = 20,765) liver transplantation (LT) on graft and patient outcomes, were presented by Tiffany Lim at the 31st International Congress of The Transplantation Society (TTS), September 20–23, 2026, Sydney, AU. The primary endpoint was 2-year graft survival. 

Key data: The hazard of graft loss was higher following DCD + SCS vs DBD LT (hazard ratio [HR], 1.79; p < 0.001), but was not statistically different with DCD + NMP (HR, 1.15; p = 0.069), DCD + NRP (HR, 1.14; p = 0.3), or DCD + NRP + NMP (HR, 1.04; p = 0.8) vs DBD LT. In propensity score-matched analysis, 2-year graft survival was lower with DCD + SCS vs matched DBD (82% vs 90%; p < 0.001) but was comparable between DBD and DCD grafts preserved with advanced perfusion techniques. Among recipients with Model for End-Stage Liver Disease (MELD) scores ≥30, DCD + NRP (HR, 2.10; p = 0.027) and DCD + SCS (HR, 2.01; p = 0.021) were associated with a higher hazard of graft loss vs DBD LT, whereas NMP-containing strategies were not associated with an increased hazard of graft loss in this subgroup.  

Key learning: These findings suggest that advanced perfusion strategies may mitigate risks associated with DCD liver grafts preserved with SCS, with graft survival comparable to DBD LT. However, in recipients with high MELD scores, outcomes following DCD grafts recovered using NRP were inferior to DBD grafts, suggesting that additional preservation strategies, such as NMP, may be needed in this high-risk population.