Machine-perfused Donation After Circulatory Death Grafts Improve Access to Liver Transplant for Primary Biliary Cholangitis Patients.

Background: Primary biliary cholangitis (PBC) is a small-duct cholangiopathy that can lead to end-stage liver disease requiring liver transplantation (LT). Use of donation after circulatory death (DCD) donors in this population has been limited by historic concerns of severe biliary complications and inferior graft outcomes. Recent regulatory approval of normothermic machine perfusion (MP) technology has dramatically improved DCD utilization. However, outcomes of DCD-MP grafts in PBC recipients remain poorly defined. Methods: We performed a retrospective analysis of adult, first-time, deceased-donor LT recipients with PBC using the Organ Procurement and Transplantation Network registry (2015-2025). Recipients were stratified by donation after brain death with cold storage (DBD-CS), DCD-CS, and DCD-MP. Kaplan-Meier and multivariable Cox regression were used to estimate 1-y graft survival and adjusted hazard ratios. Temporal trends were assessed with Poisson regression. Results: < 0.001). Conclusions: DCD-MP achieved 1-y graft survival comparable to DBD-CS in PBC LT recipients, supporting broader consideration of this strategy. Rapid growth in DCD-MP utilization reflects increasing programmatic confidence in contemporary preservation practices for PBC patients.