Ischemia‐Free Implantation of a 75‐Year‐Old DCD Liver After Normothermic Regional Perfusion: A First‐in‐Human Report

ABSTRACT Background Donation after circulatory death (DCD) organs are associated with compromised transplant outcomes and limited utilization. Normothermic regional perfusion (NRP) has been shown to significantly improve organ quality and transplant outcomes. Our group previously demonstrated the feasibility and efficacy of ischemia‐free liver implantation (IFLI) using grafts from donation after brain death. We hypothesized that NRP sequential IFLI would be feasible and effective in DCD liver transplantation. This study presents clinical case attempts that validate the viability of this hypothesis. Methods We report the first case of IFLI of a DCD liver following NRP. The graft was donated by a 75‐year‐old man with a total warm ischemia time of 24 min. The abdominal organs underwent 67 min of NRP. The liver was then cold‐stored in University of Wisconsin solution and transported, with a total cold ischemia time of 548 min. After back‐table preparation, the liver was subjected to 373 min of normothermic machine perfusion (NMP) before being implanted using an ischemia‐free implant technique. Results Perfusion parameters, lactate clearance, and liver enzyme levels during in situ NRP indicated that the liver was transplantable. In addition, perfusion parameters, lactate clearance, and bile production during ex situ NMP fulfilled the VITTAL criteria for transplantation. The recipient was a 65‐year‐old woman with primary biliary cirrhosis. The peak post‐transplant alanine aminotransferase level was 77 U/L, and liver function normalized within 9 days after surgery. The patient recovered uneventfully, with no evidence of early allograft dysfunction or other major complications, and was discharged on day 16 post‐transplantation. Conclusions This first report demonstrates the feasibility of NRP sequential IFLI in DCD liver transplantation.