ArticleClinical transplantation2026
Re-Evaluating Donor-Recipient Risk Scores in the Machine Perfusion Era Using a Large Multicenter Cohort: Do Traditional Predictive Models Still Apply?
Article in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWith increasing use of donation after circulatory death (DCD) donor grafts, the need for accurate risk-stratification tools in liver transplantation has become critical. Machine perfusion has been shown to improve both graft and patient survival. However, existing prediction models were developed in the static cold storage (SCS) era and their accuracy when using machine perfusion remains unknown. Our study aims to study if current scoring systems can predict graft and patient survival for DCD livers preserved using normothermic machine perfusion (NMP).
methodsThis was a retrospective study of patient and graft survival in a two-center U.S. DCD NMP cohort (n = 532) between January 2022 and December 2024. Predicted graft and patient survival rates were obtained from established risk scoring systems, including the United Kingdom DCD risk score (UK-DCD), Early Allograft Dysfunction (EAD) Olthoff score, Liver Graft Assessment Following Transplantation (L-GrAFT
resultsAcross scoring systems, predicted survival consistently underestimated actual graft and patient survival in the NMP DCD cohort. The DRI, SOFT, EAD and L-GrAFT
conclusionExisting liver transplant risk scores show limited predictive value for donor-related risk factors in the NMP era, whereas recipient-related factors remain somewhat predictive, despite overestimating risk. Early allograft dysfunction metrics were not reliable predictors of short or long-term outcomes. Future risk models should integrate machine-perfusion parameters and refined donor variables to reflect outcomes more accurately in contemporary DCD liver transplantation.
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