Introduction: Normothermic machine perfusion (NMP) has been shown to facilitate the use of marginal liver allografts and may reduce early graft dysfunction (EAD) and ischemic cholangiopathy. Newer evidence shows trends towards shorter operative times and shorter ICU stays. These benefits may also extend to grafts that will ultimately be used for pediatric split liver transplant. In this analysis, we performed a real-world comparison of early post-operative outcomes between NMP and static cold storage (SCS) in pediatric left lateral segment liver transplantation.

Methods: Operative metrics and post-operative outcomes were compared for pediatric patients who underwent ex-situ split left lateral segment liver transplantation following preservation in either NMP (TransMedics Liver Organ Care System) or SCS between January 1, 2021 to August 15, 2023. Additional analysis of adult recipients of the split right liver segment following initial preservation in NMP or SCS was performed. The nonparametric Wilcoxon-Rank test was used for continuous variables while Fisher’s exact test was performed for categorical variables.

Results: Four NMP and eight SCS recipients were included in our analysis for left lateral segment recipients. Two NMP and two SCS recipients were included in our analysis for right segment recipients. All attempts were made to utilize the right liver segment following ex-situ split when able and anatomically feasible. Donor and recipient baseline characteristics were not significantly different. All grafts were obtained following Donation after Brain Death (DBD). Total preservation time was significantly longer for NMP livers (732 vs 384 minutes, p <0.001). The NMP cohort had significantly shorter ICU stays (4 vs 15.6 days, p <0.04). There were no significant differences in the adult recipients of the right liver segment though there was a trend to shorter overall hospital stay.

Conclusion: In this single center analysis, we found that NMP reduces ICU length of stay in left lateral segment liver transplantation while allowing for longer preservation times which has the potential to assist with managing transplant logistics and the expanding geographic donor pool.