ATC 2023 Poster Abstracts

Abstract

Purpose: Normothermic mechanical perfusion (NMP) for liver transplantation could be revolutionary. We report differences in center practice and outcomes before and after institution of an NMP program using Transmedics™ Liver OCS in a high volume liver transplant program. Methods: We performed a single center cohort study of all DDLTs performed between 1/1/20-12/1/22. NMP program implementation began in January 2022. Recipient, donor, and clinical outcome data were collected from institutional medical records. We utilized univariate statistical methods to assess variation in center outcomes before (Pre-NMP, 1/1/20-12/31/21) and after NMP program initiation (Post-NMP (1/1/22-12/1/22), related to procurement practice, operative time, transfusions, liver utilization, hospital use, early allograft dysfunction, ischemic cholangiopathy, and graft survival by graft type (donation after circulatory death (DCD) and brain death (DBD) and preservation type (static cold storage (SCS) vs NMP)). Results: A total of 616 LTs (DCD LT n= 299 (48.5%), DBD LT n=317 (51.5%) were performed during the study period (Figure). The pattern of preservation approach changed significantly by graft type. Post-NMP, DCD-NMP accounted for 75% of DCD LT and 38% DBD LT. Annual DCD LT volume increased each year (2020, n=73; 2021, n=92; 2022, n=134). Year-over-year DCD LT volume growth was significantly higher post-NMP (2021-2022=46% vs. 2020-2021=26%, p<0.05). Median preservation time for all LTs nearly doubled post-NMP (p<0.05). For utilization of DCD livers > 1000 miles away, 15 DCD-NMP cases were completed versus 3 DCD-SCS pre-NMP. Operative times were shortest among DCD-NMP cases (p<0.05). Among post-NMP DCD LT, EAD was 25% lower in DCD-NMP vs DCD-SCS. DCD-NMP cases demonstrated no ischemic cholangiopathy. For DCD LT, graft survival at last follow-up improved significantly for post-NMP (Figure). Conclusions: Implementation of an NMP program in a high-volume LT program dramatically changed center practice and improved clinical outcomes, particularly in DCD LT. Dissemination of best practices with granular clinical data are critical to optimize NMP use, liver utilization, and recipient outcomes. CITATION INFORMATION: Mathur A., Aqel B., Luque Villa E., Nguyen M., Nuñez Nateras R., Hewitt W., Harbell J., Jadlowiec C., Katariya N., Singer A., Frasco P., Moss A., Reddy K. Liver Transplant Center Practice and Outcome Variation Following Institution of a NMP Program: Real-World Experience from a High Volume Us Center AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: A.K.Mathur: Other - Travel support for device training;; Transmedics. A.Singer: n/a. P.Frasco: n/a. A.Moss: n/a. K.Reddy: n/a. B.Aqel: None. E.Luque villa: n/a. M.Nguyen: None. R.Nuñez nateras: n/a. W.Hewitt: n/a. J.Harbell: n/a. C.Jadlowiec: None. N.Katariya: n/a. [Figure presented]