TY - JOUR
T1 - Impact of Back-to-Base Normothermic Machine Perfusion on Complications and Costs
T2 - A Multicenter, Real-World Risk-Matched Analysis
AU - Wehrle, Chase J.
AU - Zhang, Mingyi
AU - Khalil, Mazhar
AU - Pita, Alejandro
AU - Modaresi Esfeh, Jamak
AU - Diago-Uso, Teresa
AU - Kim, Jaekeun
AU - Aucejo, Federico
AU - Kwon, David C.H.
AU - Ali, Khaled
AU - Cazzaniga, Beatrice
AU - Miyazaki, Yuki
AU - Liu, Qiang
AU - Fares, Sami
AU - Hong, Hanna
AU - Tuul, Munkhbold
AU - Jiao, Chunbao
AU - Sun, Keyue
AU - Fairchild, Robert L.
AU - Quintini, Cristiano
AU - Fujiki, Masato
AU - Pinna, Antonio D.
AU - Miller, Charles
AU - Hashimoto, Koji
AU - Schlegel, Andrea
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Objective: Assess cost and complication outcomes after liver transplantation (LT) using normothermic machine perfusion (NMP). Background: End-ischemic NMP is often used to aid logistics, yet its impact on outcomes after LT remains unclear, as does its true impact on costs associated with transplantation. Methods: Deceased donor liver recipients at 2 centers (January 1, 2019, to June 30, 2023) were included. Retransplants, splits, and combined grafts were excluded. End-ischemic NMP (OrganOx-Metra) was implemented in October 2022 for extended-criteria donation after brain death (DBDs), all donations after circulatory deaths (DCDs), and logistics. NMP cases were matched 1:2 with static cold storage controls (SCS) using the Balance-of-Risk [donation after brain death (DBD)-grafts] and UK-DCD Score (DCD-grafts). Results: Overall, 803 transplantations were included, 174 (21.7%) receiving NMP. Matching was achieved between 118 NMP-DBDs with 236 SCS; and 37 NMP-DCD with 74 corresponding SCS. For both graft types, median inpatient comprehensive complications index values were comparable between groups. DCD-NMP grafts experienced reduced cumulative 90-day comprehensive complications index (27.6 vs 41.9, P=0.028). NMP also reduced the need for early relaparotomy and renal replacement therapy, with subsequently less frequent major complications (Clavien-Dindo ≥IVa). This effect was more pronounced in DCD transplants. NMP had no protective effect on early biliary complications. Organ acquisition/preservation costs were higher with NMP, yet NMP-treated grafts had lower 90-day pretransplant costs in the context of shorter waiting list times. Overall costs were comparable for both cohorts. Conclusions: This is the first risk-adjusted outcome and cost analysis comparing NMP and SCS. In addition to logistical benefits, NMP was associated with a reduction in relaparotomy and bleeding in DBD grafts, and overall complications and post-LT renal replacement for DCDs. While organ acquisition/preservation was more costly with NMP, overall 90-day health care costs-per-transplantation were comparable.
AB - Objective: Assess cost and complication outcomes after liver transplantation (LT) using normothermic machine perfusion (NMP). Background: End-ischemic NMP is often used to aid logistics, yet its impact on outcomes after LT remains unclear, as does its true impact on costs associated with transplantation. Methods: Deceased donor liver recipients at 2 centers (January 1, 2019, to June 30, 2023) were included. Retransplants, splits, and combined grafts were excluded. End-ischemic NMP (OrganOx-Metra) was implemented in October 2022 for extended-criteria donation after brain death (DBDs), all donations after circulatory deaths (DCDs), and logistics. NMP cases were matched 1:2 with static cold storage controls (SCS) using the Balance-of-Risk [donation after brain death (DBD)-grafts] and UK-DCD Score (DCD-grafts). Results: Overall, 803 transplantations were included, 174 (21.7%) receiving NMP. Matching was achieved between 118 NMP-DBDs with 236 SCS; and 37 NMP-DCD with 74 corresponding SCS. For both graft types, median inpatient comprehensive complications index values were comparable between groups. DCD-NMP grafts experienced reduced cumulative 90-day comprehensive complications index (27.6 vs 41.9, P=0.028). NMP also reduced the need for early relaparotomy and renal replacement therapy, with subsequently less frequent major complications (Clavien-Dindo ≥IVa). This effect was more pronounced in DCD transplants. NMP had no protective effect on early biliary complications. Organ acquisition/preservation costs were higher with NMP, yet NMP-treated grafts had lower 90-day pretransplant costs in the context of shorter waiting list times. Overall costs were comparable for both cohorts. Conclusions: This is the first risk-adjusted outcome and cost analysis comparing NMP and SCS. In addition to logistical benefits, NMP was associated with a reduction in relaparotomy and bleeding in DBD grafts, and overall complications and post-LT renal replacement for DCDs. While organ acquisition/preservation was more costly with NMP, overall 90-day health care costs-per-transplantation were comparable.
KW - complications
KW - costs
KW - health care costs
KW - liver transplantation: normothermic machine perfusion
UR - https://www.scopus.com/pages/publications/85197801399
U2 - 10.1097/SLA.0000000000006291
DO - 10.1097/SLA.0000000000006291
M3 - Article
C2 - 38557793
AN - SCOPUS:85197801399
SN - 0003-4932
VL - 280
SP - 300
EP - 310
JO - Annals of Surgery
JF - Annals of Surgery
IS - 2
ER -