Machine perfusion cut early complications after liver transplant by 40%

Design

PRISMA 2020-compliant systematic review and random-effects meta-analysis of 5 comparative studies (2 randomised trials, 3 observational cohorts)

Population

630 liver transplant recipients, organs preserved by normothermic machine perfusion or static cold storage

Primary outcome

composite early postoperative complications

Effect

RR 0.60 (95% CI 0.47-0.75), p<0.0001, I² 0%; no effect modification by design, donation type, preservation duration, donor age or technique

A meta-analysis identified five comparative studies of normothermic machine perfusion against static cold storage for donor livers — two randomised trials and three observational cohorts, 630 recipients in total — and pooled composite early postoperative complications.

Machine perfusion reduced the composite by 40% (RR 0.60, 95% CI 0.47-0.75, p<0.0001), with no heterogeneity between studies (I² 0%). Subgroup analyses found no effect modification by study design (p = 0.75), proportion of donation after circulatory death (p = 0.91), preservation duration (p = 0.51), donor age (p = 0.59) or perfusion technique (p = 0.37).

That design made no difference is worth noting in both directions: it argues the observational cohorts were not exaggerating the effect, and it means only two randomised trials sit behind a result now consistent across five studies. The composite endpoint is the softer part — 'early postoperative complications' bundles events of very different weight, and the paper's value is in the consistency rather than the precision. The practical implication is about marginal organs: if perfusion reliably improves early outcomes, livers currently declined become usable, which matters most where the donor pool is smallest.

• A composite of early complications is not graft survival or mortality; those need longer follow-up
• The consistency across designs and subgroups is the strongest feature of this analysis
• Only 630 recipients and two randomised trials underlie the estimate
• The case for perfusion is strongest for marginal and donation-after-circulatory-death organs
• Capital and consumable costs are the barrier in most Indian transplant units, not the evidence

Why it matters

If perfusion makes marginal organs usable, it changes the size of the donor pool rather than just the quality of the operation.

Don't overread it

Five studies, two of them randomised, and a composite endpoint — this is not evidence of a survival benefit.

The statistics, in plain English

I² of 0% means the five studies agreed almost exactly, which is unusual and strengthens the pooled estimate. But a composite outcome can be driven by its least serious component: a 40% reduction in 'early postoperative complications' may reflect fewer episodes of biochemical dysfunction rather than fewer graft losses, and this analysis cannot distinguish them.

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