Normothermic machine perfusion (NMP) facilitates utilization of marginal liver allografts. It remains unknown whether clinical benefits offset additional costs in the real-world setting. We performed a comparison of outcomes and hospitalization costs for donor livers preserved by NMP versus static cold storage (SCS) at a high-volume center. Adult patients receiving deceased donor liver transplants preserved by either NMP (TransMedics Organ Care System) or SCS between January 1, 2021-December 31, 2023 were included. Donor and recipient characteristics, operative parameters, post-transplant outcomes, and hospitalization costs were compared. A total of 144 NMP and 149 SCS cases were included. A higher proportion of NMP cases were DCD (38.2% vs. 4.7%, p<0.001). Despite significantly higher LDRI (2.1 vs 1.7, p<0.001) and longer preservation time, (877 min vs. 355 min, p<0.001), NMP recipients experienced lower rates of reperfusion syndrome (4.3% vs 32.9%, p<0.001), less blood loss (1.5 L vs. 3.0 L, p<0.001), and required less blood product transfusion. This resulted in shorter operative time for NMP cases (357 min vs 438 min, p<0.001) and significant reductions in both ICU (3 days vs. 5 days, p=0.005) and hospital length of stay (11 days vs. 13 days, p=0.03). NMP facilitated the transition of cases to daytime hours (88.9% vs 46.3%, p<0.001). Despite the clinical and logistical benefits observed, index hospitalization costs were significantly higher in the NMP cohort ($256,810 vs. $209,144, p<0.001), driven largely by higher organ acquisition costs ($135,930 vs $50,940, p<0.001). In conclusion, utilization of NMP comes with an attendant increase in cost but provides substantial clinical benefit. Transplant programs must weigh these considerations in their practice environments before initiating an NMP program.
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.