Cradle compression during normothermic machine perfusion of livers – struggling under the weight of expectation?

Normothermic machine perfusion (NMP) increases utilisation of deceased liver grafts 1. It enables real time assessment of graft viability and, by enabling grafts to be preserved for longer, offsets logistical problems such as concurrent liver offers and changes in intended liver recipient. Cradle compression (CC) has emerged as a unique problem affecting liver grafts perfused on NMP. Essentially a Computed Tomography (CT) diagnosis, CC describes the heterogeneous opacification – typically in the dome of the right lobe - observed on imaging of recipients of liver grafts that had undergone NMP. During NMP, the liver is placed in a non-anatomical position with the vessels facing anteriorly, and CC is thought to reflect pressure necrosis and impaired portal inflow to the most dependant part of the liver.