Cradle Compression During Normothermic Machine Perfusion in Liver Transplantation: Incidence and Impact on Postoperative Outcomes.

BACKGROUND Normothermic machine perfusion (NMP) has improved liver preservation, but cradle compression (CC)-a pressure-related graft injury during perfusion-remains poorly characterized. This study evaluated the incidence, risk factors, and clinical impacts of CC after NMP.

METHODS Among 145 liver transplants with NMP, 78 recipients underwent postoperative abdominal computed tomography within 30 d and were analyzed. CC was classified radiologically into grades 1-3. Postoperative outcomes, complications, and graft survival were compared by CC severity, and logistic regression was used to identify risk factors.

RESULTS CC was identified in 27 patients (34.6%): grade 1 (n = 6), grade 2 (n = 12), and grade 3 (n = 9). Patients with CC had significantly higher peak alanine aminotransferase within 7 d (2059 ± 188 versus 336 ± 83 U/L; P < 0.001), higher bilirubin and international normalized ratio at day 7, and more frequent early allograft dysfunction (61% versus 13%; P < 0.001), particularly in grade 3 CC (89%). Grade 3 CC was also associated with prolonged vasopressor use (78.4 ± 15.9 versus 10.3 ± 7.0 h; P < 0.001), longer ventilation (P = 0.008), severe acute kidney injury (60%, all stage 3; P = 0.030), extended ICU and hospital stays (P < 0.05), and higher Comprehensive Complication Index at discharge (50.9 ± 9.6 versus 29.1 ± 4.3; P = 0.041). Liver-related graft survival decreased with CC severity (P = 0.036), with the poorest outcomes in grade 3. Donor age >48 y and graft weight >1900 g were independent risk factors.

CONCLUSIONS Although limited to recipients who underwent postoperative computed tomography, CC was strongly associated with adverse outcomes, especially in grade 3 cases. Donor age and graft weight were the risk factors.