Evidence map›Paper›PMID 42132388›Full record

ArticleLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society2026

A diagnostic accuracy study of mitochondrial FMN during hypothermic oxygenated perfusion to guide liver utilization and avoid normothermic assessment.

Janina Eden, Sabrina Stimmeder, Adam M Thorne, Linda C Woltjes, Vivianne Veenma, Minou de Bree, Cornelia W Binnekamp, Wouke N Kuiper, Philipp Dutkowski, Vincent E de Meijer

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Article in Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Janina EdenDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Sabrina StimmederDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Adam M ThorneDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Linda C WoltjesDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Vivianne VeenmaUMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, The Netherlands.
Minou de BreeUMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, The Netherlands.
Cornelia W BinnekampUMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, The Netherlands.
Wouke N KuiperUMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, The Netherlands.
Philipp DutkowskiDepartment of Surgery, University Hospital of Basel, Basel, Switzerland.
Vincent E de MeijerDepartment of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Extended-criteria donation after circulatory death (ECD-DCD) livers require functional assessment to ensure safe utilization. Sequential (dual) hypothermic oxygenated machine perfusion ((D)HOPE) with controlled oxygenated rewarming (COR) followed by normothermic machine perfusion (NMP) enables viability assessment of ECD-DCD grafts while promoting mitochondrial recovery. Previous work has investigated the added value of flavin mononucleotide (FMN) in risk stratification during DHOPE. This diagnostic accuracy study aimed to compare the predictive value of FMN release during DHOPE with bile quality assessment during subsequent COR-NMP in consecutively accepted ECD-DCD livers. FMN concentrations were measured fluorometrically in perfusate samples collected during DHOPE and not used to guide clinical decisions on transplantability. Viability assessment after 2.5 hours of NMP served as the reference standard. Associations between FMN levels and graft utilization were evaluated using receiver operating characteristic analyses. A total of 103 ECD-DCD livers were included, of which 67% were transplanted. FMN demonstrated discriminative ability for graft nonutilization based on bile quality assessment, with AUROC of 0.74 (95% CI: 0.60-0.86) at 30 minutes, 0.75 (95% CI: 0.63-0.85) at 60 minutes, and 0.70 (95% CI: 0.56-0.83) at 120 minutes of DHOPE. Exploratory FMN thresholds showed increasing specificity and positive predictive value over time, reaching 0.92 (95% CI: 0.83-0.98) and 0.75 (95% CI: 0.53-0.94), respectively, at 120 minutes. Transplanted livers had significantly lower FMN concentrations than declined livers at all time points, with Youden-optimal cutoffs of 9.32, 20.97, and 45.53 ng/mL at 30, 60, and 120 minutes, respectively. FMN release during DHOPE is associated with subsequent NMP viability outcomes in ECD-DCD livers. FMN concentrations may help identify viable and nonviable grafts early during DHOPE, potentially avoiding resource-intensive comprehensive viability assessment with COR-NMP.

Indexed as

Liver TransplantationOrgan PreservationPerfusionAllograftsBileFemaleHumansLiverMaleMiddle AgedPredictive Value of TestsRewarmingRisk AssessmentTissue Donorsbiomarkerhypothermic oxygenated machine perfusionliver transplantationmachine perfusionnormothermic machine perfusionrisk stratification

Identifiers

PMID42132388
PMCPMC13668031

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.