Carter J. Burns

Background/Objectives: There is a critical disparity between donor organs and recipients awaiting liver transplantation. Normothermic machine perfusion (NMP) has emerged as a promising strategy with which to address this shortage. This study aimed to evaluate the association between NMP and short-term outcomes following liver transplantation using a large, multivariable-adjusted national dataset. Methods: A retrospective analysis of the de-identified United Network for Organ Sharing (UNOS) database was conducted for adult liver transplant recipients between January 2020 and July 2024. Standard and deceased donor data were merged according to donor identification number. Multivariable logistic and Cox regression models were used to evaluate patient mortality, graft failure, and hospital length of stay (LOS). Results: Among 34,115 patients, adjusted regression demonstrated lower one-year patient mortality (OR 0.68, CI 0.54–0.86, p = 0.001) and graft failure (OR 0.72, CI 0.60–0.87, p = 0.001) with NMP compared to static cold storage. NMP was also associated with reduced 30-day (OR 0.67, CI 0.47–0.95, p = 0.03) and 90-day mortality (OR 0.72, CI 0.54–0.94, p = 0.02) and shorter LOS (HR 1.06, CI 1.01–1.12, p = 0.02). Kaplan–Meier and Cox analyses showed no significant differences in overall patient mortality or graft failure. Conclusions: NMP was associated with improved short-term survival in time-independent analysis; however, it failed to reach significance in time-dependent Cox regression. These findings suggest that NMP could play a role in improving short-term outcomes and expanding the donor pool for liver transplant candidates. Additional studies are needed to fully elucidate the impact of NMP on short-term survival outcomes.

Background.: Consideration of both donor and recipient factors at the time of an organ offer is crucial in achieving the most optimal outcome given the shortage of available donor organs and waitlist mortality risk. Our aim was to achieve a comprehensive risk assessment for liver transplant patients by creating a series of independent risk index equations for 6 distinct posttransplant endpoints in the transplant continuum of care. Methods.: The Survival Outcomes Following Liver Transplantation (SOFT) Cluster score includes risk indices for patient mortality at 90 d, 1 y, 3 y, and 5 y posttransplant, graft failure at 1 y after transplantation, and prolonged length of stay (>30 d). Using a total sample of 61 231 patients, significant risk and protective factors were identified through univariable and multivariable analysis from a training set of 40 821 patients from the Organ Procurement and Transplantation Network database. Results.: When applied to a validation set of 20 410 patients, the SOFT Cluster score has a C -statistic of 0.66 for 90-d mortality, 0.64 for 1-y mortality, 0.63 for 3-y mortality, 0.63 for 5-y mortality, 0.76 for prolonged length of stay, and 0.60 for 1-y graft failure. Conclusions.: The SOFT Cluster score represents a novel proof-of-concept model for posttransplant risk assessment and provides physicians with a more holistic understanding of patient risk by examining a spectrum of outcomes after liver transplantation up to 5 y posttransplant using a modern cohort of recipients.