Advanced Perfusion Techniques Level Liver Transplantation Outcomes With Different Donor Types: A Propensity Score-matched Analysis

BACKGROUND: Advanced perfusion techniques have been shown to improve liver transplantation (LT) outcomes in donation after determination of death by both circulatory (DCD) and neurological (DBD) criteria, but allocation strategies are still controversial. METHODS: This study compared the outcomes of controlled DCD LT with normothermic regional perfusion and subsequent ex situ machine perfusion to those of DBD LT with static cold storage and extended criteria DBD (ECD) LT with dual hypothermic oxygenated perfusion (DHOPE), selected by propensity score matching. RESULTS: Three comparable cohorts were selected from transplants performed between January 2016 and June 2024: 61 DCD (DHOPE, n = 50; normothermic machine perfusion, n = 11), 122 DBD-static cold storage, and 122 ECD-DHOPE. Median functional warm ischemia time in DCD donors was 44 (39-48) min. Livers were assessed and accepted for LT based on normothermic regional perfusion parameters. All considered outcomes were comparable between groups and in line with benchmark values. One-year graft and patient survival exceeded 90% in all groups, whereas 3-y graft survival was 91.8%, 93.4%, and 88% in the DCD, DBD-static cold storage, and ECD-DHOPE groups, respectively. In the same groups, incidence of ischemic cholangiopathy was 3.3%, 4.9%, and 3.3%. CONCLUSIONS: Tailored application of advanced perfusion techniques allows achieving optimal outcomes in both DCD with prolonged warm ischemia time and ECD-DBD LT.