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Objective: A randomized controlled clinical trial comparison of conventional low temperature storage of transplant donor livers (static cold storage, SCS) with storage of the organs at physiological body temperature (normothermic machine preservation, NMP) Background: The high success rate of liver transplantation is constrained by the shortage of transplantable organs (e.g. waiting list mortality >20% in many centers). Normothermic machine perfusion maintains the liver in a functioning state to improve preservation quality and enable testing of the organ before transplantation. This is of greatest potential value with organs from brain-dead donor organs (DBD) with risk factors (age, comorbidities), and those from donors declared dead by cardiovascular criteria (DCD). Methods: 383 donor organs were randomized by 15 US liver transplant centers to undergo NMP (n=192) or SCS (n=191). 266 donor livers proceeded to transplantation (NMP n=136; SCS n=130). The primary endpoint of the study was Early Allograft Dysfunction (EAD), a marker of early post-transplant liver injury and function. Results: The difference in incidence of EAD did not achieve significance, with 20.6% (NMP) vs. 23.7% (SCS). Using exploratory ‘as-treated’ rather than “intent to treat” sub-group analyses, there was a greater effect size in DCD donor livers (22.8% NMP vs. 44.6% SCS), and in organs in the highest risk quartile by donor risk (19.2% NMP vs. 33.3% SCS). The incidence of acute cardiovascular decompensation at organ reperfusion, ‘post-reperfusion syndrome’ as a secondary outcome was reduced in the NMP arm (5.9% vs. 14.6%). Conclusions: Normothermic machine perfusion did not lower EAD perhaps related to inclusion of lower risk liver donors, as higher risk donor livers appeared to benefit more The technology is safe in standard organ recovery, and appears to have greatest benefit in marginal donors.

Traditional surgical techniques of open donor nephrectomy have transitioned to minimally invasive techniques. With adoption of these techniques as the preferred approach, several variations have and continue to evolve. The current minimally invasive donor nephrectomy techniques share low complication rates and excellent outcomes.

Background. Outcomes of liver transplantation (LT) from donation after circulatory death (DCD) have been improving; however, ischemic cholangiopathy (IC) continues to be a problem. In 2014, measures to minimize donor hepatectomy time (DHT) and cold ischemic time (CIT) have been adopted to improve DCD LT outcomes. Methods. Retrospective review of all patients who underwent DCD LT between 2005 and 2017 was performed. We compared outcomes of patients who were transplanted before 2014 (historic group) with those who were transplanted between 2014 and 2017 (modern group). Results. We identified 112 patients; 44 were in the historic group and 68 in the modern group. Donors in the historic group were younger (26.5 versus 33, P = 0.007) and had a lower body mass index (26.2 versus 28.2, P = 0.007). DHT (min) and CIT (h) were significantly longer in the historic group (21.5 versus 14, P < 0.001 and 5.3 versus 4.2, P < 0.001, respectively). Fourteen patients (12.5%) developed IC, with a significantly higher incidence in the historic group (23.3% versus 6.1%, P = 0.02). There was no difference in graft and patient survival between both groups. Conclusion. In appropriately selected recipients, minimization of DHT and CIT may decrease the incidence of IC. These changes can potentially expand the DCD donor pool.