Abstract
The use of normothermic machine perfusion over static cold storage in liver transplantation has been shown to reduce post-transplant risks of early allograft dysfunction, primary nonfunction, and ischemic cholangiopathy, and its increasing use has played a role in the expanded utilization of marginal livers. While studies have demonstrated improved clinical outcomes utilizing normothermic machine perfusion over static cold storage preservation, real-time intraoperative data reflecting the quality and viability of normothermic machine perfusion livers is limited. This retrospective, single-center study compared normothermic machine perfusion vs static cold storage livers in first-time liver transplant recipients through the evaluation of synthetic coagulation function as measured by thromboelastography and conventional coagulation testing. Secondarily, transfusion utilization between the two cohorts were reviewed. 186 liver transplant recipients receiving allografts from donors after circulatory death were included in the study, of which 99 (53%) allografts were preserved in static cold storage, and 87 (47%) allografts were placed on the TransMedics Organ Care System. Study findings showed normothermic machine perfusion livers supported with the TransMedics Organ Care System were associated with increased synthetic coagulation function and less excess fibrinolysis in the post-reperfusion period compared to static cold storage livers, and that these findings were better reflected in real-time with thromboelastography monitoring vs conventional coagulation testing. Following reperfusion, there was a significant decrease in the transfusion of blood products in the normothermic machine perfusion group compared with that in the static cold storage group. Overall, we determined that the use of intraoperative thromboelastography can provide real-time data to assess one aspect of reperfusion liver quality and viability.