Heterogeneous indications and the need for viability assessment: An international survey on the use of machine perfusion in liver transplantation

• Published in: Artificial organs 2022-02, Vol.46 (2), p.296-305
• Main Authors: Patrono, Damiano, Cussa, Davide, Rigo, Federica, Romagnoli, Renato, Angelico, Roberta, Bellini, Maria Irene, Bonaccorsi‐Riani, Eliano, Brüggenwirth, Isabel M. A., Czigany, Zoltan, De Carlis, Riccardo, De Meijer, Vincent E., Dondossola, Daniele, Eshmuminov, Dilmurodjon, Ghinolfi, Davide, Hessheimer, Amelia J., Kollmann, Dagmar, Lai, Quirino, Lurje, Georg, Manzia, Tommaso M., Merhabi, Arianeb, Melandro, Fabio, Nasralla, David, Nickkholgh, Arash, Pagano, Duilio, Rayar, Michel, Saffioti, Maria Cristina, Weissenbacher, Annemarie, Avolio, Alfonso W., De Simone, Paolo, Fondevila, Costantino, Jassem, Wayel, Macconmara, Malcolm, Porte, Robert J., Ravaioli, Matteo, Selzner, Markus, Spada, Marco
• Format: Article
• Language: English
• Subjects: Cold Ischemia; ex situ organ perfusion; Graft Survival; Heterogeneity; Humans; Ischemia; Liver; Liver transplantation; Liver Transplantation - methods; Liver transplants; machine perfusion; Main Text; normothermic regional perfusion; organ preservation; Organ Preservation - methods; Perfusion; Perfusion - instrumentation; Perfusion - methods; Polls & surveys; Surveys and Questionnaires; Transplantation; Transplants & implants; Viability; viability assessment
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14061

Although machine perfusion (MP) is being increasingly adopted in liver transplantation, indications, timing, and modality are debated. To investigate current indications for MP a web‐based Google Forms survey was launched in January 2021 and addressed to 127 experts in the field, identified among first and corresponding Authors of MP literature in the last 10 years. The survey presented 10 real‐life cases of donor–recipient matching, asking whether the liver would be accepted (Q1), whether MP would be used in that particular setting (Q2) and, if so, by which MP modality (Q3) and at what timing during preservation (Q4). Respondents could also comment on each case. The agreement was evaluated using Krippendorff's alpha coefficient. Answers from 39 (30.1%) participants disclosed significant heterogeneity in graft acceptance, MP indications, technique, and timing. Agreement between respondents was generally poor (Q1, α = 0.11; Q2, α = 0.14; Q3, α = 0.12, Q4, α = 0.11). Overall, respondents preferred hypothermic MP and an end‐ischemic approach in 56.3% and 81.1% of cases, respectively. A total of 18 (46.2%) participants considered only one MP approach, whereas 17 (43.6%) and 3 (7.7%) considered using alternatively 2 or 3 different techniques. Of 38 comments, 17 (44.7%) were about the use of MP for graft viability assessment before implantation. This survey shows considerable variability in MP indications, emphasizing the need to identify scenarios of optimal utilization for each technique. Viability assessment emerges as a fundamental need of transplant professionals when considering the use of MP. In this survey, experts in the field of machine perfusion and liver transplantation were confronted to ten real‐world cases of donor‐recipient matching. Respondents were asked whether they would accept the offer and, if so, whether, how and when they would use machine perfusion for each case. The picture, which depicts each respondent answers, highlight significant heterogeneity with regards to graft acceptance and machine perfusion practice.