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BACKGROUND: Normothermic machine perfusion (NMP) of liver grafts is increasingly being incorporated in clinical practice. Current evidence has shown NMP plays a role in reconditioning the synthetic and energy capabilities of grafts. Intraoperative coagulation profile is a surrogate of graft quality and preservation status; however, to date this aspect has not been documented. METHODS: The LT recipients who received NMP liver grafts in the QEHB between 2013-2016 were compared in terms of intra-operative thromboelastography (TEG) characteristics (R-time, K-time, α-angle, maximum amplitude [MA], G-value and LY30) to a propensity-score matched control group, where the grafts were preserved by traditional static cold storage (SCS). RESULTS: After propensity matching, none of the TEG characteristics were found to differ significantly between the 72 pairs of SCS and NMP organs when measured pre-implantation. However, post-implantation, NMP organs had significantly shorter K-time (median: 2.8 vs. 3.6 mins, p=0.010) and R+K-time (11.4 vs. 13.7 mins, p=0.016), as well as significantly larger α-Angle (55.9vs. 44.8°, p=0.002), MA (53.5 vs. 49.6 mm, p=0.044) and G-values (5.8 vs. 4.9 kdynes/cm, p=0.043) than SCS organs. Hyperfibrinolysis after implantation was also mitigated by NMP, with fewer patients requiring aggressive factor correction during surgery [LY30=0, NMP vs. SCS: 83% vs. 60%, p=0.004]. Consequently, NMP organs required significantly fewer platelet units to be transfused during the transplant procedure (median: 0vs.5, p=0.001). CONCLUSIONS: In this study, we have shown that NMP liver grafts return better coagulation profiles intraoperatively, which could be attributed to the preservation of liver grafts under physiological conditions.

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