April’s Article of the Month, with commentary from Dr. Cale Kassel, examines a 117-patient observational cohort study from Spain comparing liver transplant outcomes between DCD donors recovered with normothermic regional perfusion (NRP) and DBD donors. Despite earlier concerns about biliary complications limiting DCD utility, the data suggest that NRP-recovered DCD organs deliver short- and medium-term outcomes comparable to DBD grafts — adding to the growing case for machine perfusion as a tool to expand the donor pool.
Key Findings
- Cohort: 117 liver transplants between November 2016 and April 2021 — 39 NRP / DCD vs. 78 DBD
- Donor profile: NRP donors were younger (52 vs. 59.4 years; p < .005) but spent more days in the ICU (7.21 vs. 2.62); DBD donors required more vasopressor support (86.4% vs. 35.1%)
- Recipient profile: Similar MELD scores between groups (14.48 vs. 16.14; p = .392); hepatocellular carcinoma was the predominant indication in the NRP group
- Graft survival: NRP showed a Kaplan-Meier curve favoring better outcomes (94% vs. 84% at one year), though not reaching statistical significance (p = .075)
- Complications: No statistically significant differences in biliary complications (NRP 12% vs. DBD 5%; p = .104), early allograft dysfunction, primary non-function, or AKI; all eight retransplants occurred in the DBD group
- Clinical implication: NRP appears to convert suboptimal DCD grafts into organs comparable to DBD, supporting broader adoption of machine perfusion to safely expand the donor pool
