Abstract

Introduction: Normothermic machine perfusion (NMP) is a promising technology for expanding the donor liver pool. This study aims to evaluate the association between the implementation of NMP on liver transplant waitlist times at a single center. Methods: We conducted a retrospective cohort study of patients who underwent liver transplant at Beth Israel Deaconess Medical Center from 2014 to 2024. Waitlist times were compared between pre-NMP and post-NMP implementation periods. Matched cohorts based on sex, age, and the model for end-stage liver disease score were used to compare patients who received machine-perfused livers (NMP group) and those who did not (non-NMP group). Waitlist duration, donor type, hospital stay, overall survival, and graft failure were measured. A subgroup of patients diagnosed with hepatocellular carcinoma (HCC) was analyzed. Results: Of 429 patients, median waitlist times were significantly reduced from 309 d pre-NMP to 48 d post-NMP (P < 0.001). In the matched analysis, the NMP group had a median waitlist time of 71 d, compared to 345 d for non-NMP group (P < 0.001). The NMP group had a 2-d shorter hospital stay than the non-NMP group (P < 0.001). For HCC patients, waitlist times decreased from 472 d pre-NMP to 83 d post-NMP (P < 0.001), and in the matched HCC cohorts, waitlist times decreased from 492 d to 121 d in the non-NMP and NMP groups, respectively (P < 0.001). Conclusions: NMP implementation was associated with significantly shorter liver transplant waitlist times and reduced hospital stays, without compromising short-term survival outcomes. NMP may address the liver transplant shortage and improve access for patients, particularly those with HCC. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.