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Lookup NU author(s): Abdullah Malik
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.Background: Machine perfusion technology has redefined donor and recipient criteria for liver transplantation. Despite increasing adoption, data regarding graft and recipient factors associated with unsuccessful normothermic machine perfusion (NMP) outcomes remain limited. Methods: The Organ Procurement and Transplantation Network database was used to retrospectively identify adult patients undergoing deceased donor liver transplantation with NMP preservation between January 10, 2021, and December 31, 2024. Populations were stratified by 1-year graft status, with donor and recipient factors compared. Logistic regression identified factors independently associated with NMP graft failure, and center analyses assessed program-level impacts. Results: Among 4928 NMP cases, 398 (8.1%) experienced 1-year graft failure. They were more frequently admitted to the intensive care unit (ICU) at transplant (21.1% vs. 10.6%, p < 0.001) and had more complex abdominal histories, including higher rates of TIPS(17.0% vs. 12.0%), prior abdominal surgery (64.1% vs. 54.7%), and prior liver transplant (10.3% vs. 3.4%) (all p < 0.01). Regression analysis identified increased odds of graft failure with MELD score 35 (aOR 2.10 [1.21–3.63]), low recipient functional status (aOR 2.05 [1.31–3.21]), and prior abdominal surgery (aOR 1.33 [1.01–1.76]). Alcohol-associated liver disease (aOR 0.36 [0.23–0.56]) was the only factor conferring a protective effect. Centers with higher-than-expected standardized NMP graft failure rates were higher-volume programs with low-risk case mixes; no centers had persistently high standardized failure rates throughout the study period. Conclusion: Recipient factors, particularly those conferring surgical complexity, are more significantly associated with NMP graft failure than donor factors. Despite increased adoption of perfusion technologies to mitigate donor and operative risk, transplant provider clinical judgment remains critical for optimizing recipient-donor matching and outcomes.
Author(s): Matevish LE, Malik AK, Harris M, Anouti A, Coe TM, Moosburner S, Raschzok N, Mufti A, Vagefi PA, Patel MS
Publication type: Article
Publication status: Published
Journal: Artificial Organs
Year: 2026
Pages: epub ahead of print
Online publication date: 18/07/2026
Acceptance date: 09/07/2026
Date deposited: 03/08/2026
ISSN (print): 0160-564X
ISSN (electronic): 1525-1594
Publisher: John Wiley and Sons Inc
URL: https://doi.org/10.1111/aor.70195
DOI: 10.1111/aor.70195
Data Access Statement: The data reported here have been supplied by the Scientific Registry of Transplant Recipients as a contractor for the Organ Procurement and Transplantation Network and are available at https:// www. srtr. org/ repor ts/ progr am- speci fic- repor ts/ . The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.
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