Normothermic Machine Perfusion Enhances Intraoperative Hepatocellular Synthetic Capacity: A Propensity-Score Matched Analysis.
Ionescu M-I., Tillakaratne S., Hodson J., Gunson B., Nasralla D., Pinter Carvalheiro da Silva Boteon A., Sermon K., Mergental H., Isaac JR., Roberts JK., Muiesan P., Friend P., Mirza DF., Bennett D., Perera MTPR.
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.