ArticleLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society2025
Transforming the logistics of liver transplantation with normothermic machine perfusion: Clinical impact versus cost.
Article in Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed.
- Machine-perfused Donation After Circulatory Death Grafts Improve Access to Liver Transplant for Primary Biliary Cholangitis Patients.Transplantation direct · 2026Article
- When Machine Perfusion Falls Short: Identifying Risks of Liver Graft Failure After Normothermic Machine Perfusion.Artificial organs · 2026Article
- Real-World Use of Normothermic Machine Perfusion in Liver Transplantation: A Multi-Institutional Experience From the National Organ Perfusion Registry.Clinical transplantation · 2026Article
- Mathematical Modeling of Liver Metabolic Activity Under Ex Vivo Conditions upon Exposure to Magnetic Nanoparticles.Biomedicines · 2026Article
- Comparing Early Graft Dysfunction Scores in Liver Transplantation After Ex-Situ Normothermic Machine Perfusion.Clinical transplantation · 2026Article
- Normothermic Machine Perfusion vs. Static Cold Storage for DBD Liver Transplantation in High-MELD Recipients: A Single-Center Retrospective Study.Journal of hepato-biliary-pancreatic sciences · 2026Article
- The Spanish transplantation model as a benchmark: clinical, societal, and economic impact of liver transplants in Spain (1984-2024).Health economics review · 2026Article
- Evolution of out-of-sequence liver allocation, 2019-2024.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Machine Perfusion Across Marginal Liver Grafts: Benefits and Challenges.Journal of personalized medicine · 2026Review
- Back-to-base Versus In-transit Machine Perfusion in Donation After Circulatory Death Liver Transplantation: Insights From a National Registry.Transplantation direct · 2026Article
- Prolonged Dual Hypothermic Oxygenated Machine Perfusion for Daytime Liver Transplant.JAMA network open · 2026Article
- Normothermia Machine Perfusion Is Associated With Reduced Transfusion Requirements, Improved Hemodynamic Stability, and Decreased Vasopressor Use During the Postreperfusion Phase of Liver Transplantation.Clinical transplantation · 2026Article
- Transplantation of older DCD livers in the machine perfusion era: a U.S. cohort study.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Outcome reporting for liver transplantation machine perfusion studies: a systematic review.EClinicalMedicine · 2026Review
- Patient perspectives on the ethics and acceptability of perfusion techniques for organ transplantation: a qualitative study.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Liver transplantation: embracing the future with machine perfusion.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2026Review
- Machine perfusion for liver transplantation: opportunities and challenges for the next generation of transplant surgeons.Frontiers in transplantation · 2026Review
- Cryopreservation Strategies to Improve Access to Organ Transplantation.Transplantation · 2026Review
- The Role of Machine Perfusion for Liver Transplantation in Children.Pediatric transplantation · 2025Review
- A Comprehensive Review ofTransplant international : official journal of the European Society for Organ Transplantation · 2025Review
Corrections and comments
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Authors and funding
23 authors.
Funding
Abstract
Normothermic machine perfusion (NMP) facilitates the utilization of marginal liver allografts. It remains unknown whether clinical benefits offset additional costs in the real-world setting. We performed a comparison of outcomes and hospitalization costs for donor livers preserved by NMP versus static cold storage at a high-volume center. Adult patients receiving deceased donor liver transplants preserved by either NMP (TransMedics Organ Care System) or static cold storage between January 1, 2021, and December 31, 2023, were included. Donor and recipient characteristics, operative parameters, post-transplant outcomes, and hospitalization costs were compared. A total of 144 NMP and 149 static cold storage cases were included. A higher proportion of NMP cases were donation after circulatory death (38.2% vs. 4.7%, p <0.001). Despite a significantly higher Liver Donor Risk Index (2.1 vs. 1.7, p <0.001) and longer preservation time (877 vs. 355 min, p <0.001), recipients of NMP experienced lower rates of reperfusion syndrome (4.3% vs. 32.9%, p <0.001), less blood loss (1.5 vs. 3.0 L, p <0.001), and required less blood product transfusion. This resulted in shorter operative time for NMP cases (357 vs. 438 min, p <0.001) and significant reductions in both intensive care unit (3 vs. 5 d, p =0.005) and hospital length of stay (11 vs. 13 d, p =0.03). NMP facilitated the transition of cases to daytime hours (88.9% vs. 46.3%, p <0.001). Despite the clinical and logistical benefits observed, index hospitalization costs were significantly higher in the NMP cohort ($256,810 vs. $209,144, p <0.001), driven largely by higher organ acquisition costs ($135,930 vs. $50,940, p <0.001). In conclusion, utilization of NMP comes with an attendant increase in cost but provides substantial clinical benefit. Transplant programs must weigh these considerations in their practice environments before initiating an NMP program.
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