Abstract：
BACKGROUND: Machine perfusion (MP) was developed to expand the donor pool and improve liver transplantation (LT) outcomes. Despite optimal results in clinical trials, the real-world MP benefit in centers with low-/mid-volume activity (LVCs) is still being determined.
METHODS: Online survey on MP for LT, distributed to worldwide LT-centers representatives. Variables of interest included logistics, technicalities, and outcomes. Responders were grouped into high-volume centers (HVCs) (>60 LTs/year) and LVCs and results compared.
RESULTS: Sixty-seven centers were included, 36 HVCs and 31 LVCs. Significant differences in MP regarded: (I) existence of an established program (80.6% vs. 41.9%; p = 0.02), (II) presence of a dedicated perfusionist (58.3% vs. 22.6%; p = 0.006), (III) duration (>4 h: 47.2% vs. 16.1%; p = 0.01), (IV) routine use (20%-40% vs. 5%-20%; p = 0.002), (V) graft utilization (>50%: 75% vs. 51.6%; p = 0.009), (VI) 90-day patient-survival (90%-100% vs. 50%-90%; p = 0.001) and (VII) subjectively perceived benefit (always vs. only in selected ECD; p = 0.009). Concordance was found for indications, type, viability tests, graft-salvage, 90-day graft-loss, and major-complications.
CONCLUSIONS: This study captured a picture of MP in real-world LT-practice. Significant disparities have surfaced between LVCs and HVCs regarding logistics, utilization, and results. To close this gap, efforts should be made to more efficiently deliver dedicated support, training and mentoring to LVC teams adopting MP technology.
METHODS: Online survey on MP for LT, distributed to worldwide LT-centers representatives. Variables of interest included logistics, technicalities, and outcomes. Responders were grouped into high-volume centers (HVCs) (>60 LTs/year) and LVCs and results compared.
RESULTS: Sixty-seven centers were included, 36 HVCs and 31 LVCs. Significant differences in MP regarded: (I) existence of an established program (80.6% vs. 41.9%; p = 0.02), (II) presence of a dedicated perfusionist (58.3% vs. 22.6%; p = 0.006), (III) duration (>4 h: 47.2% vs. 16.1%; p = 0.01), (IV) routine use (20%-40% vs. 5%-20%; p = 0.002), (V) graft utilization (>50%: 75% vs. 51.6%; p = 0.009), (VI) 90-day patient-survival (90%-100% vs. 50%-90%; p = 0.001) and (VII) subjectively perceived benefit (always vs. only in selected ECD; p = 0.009). Concordance was found for indications, type, viability tests, graft-salvage, 90-day graft-loss, and major-complications.
CONCLUSIONS: This study captured a picture of MP in real-world LT-practice. Significant disparities have surfaced between LVCs and HVCs regarding logistics, utilization, and results. To close this gap, efforts should be made to more efficiently deliver dedicated support, training and mentoring to LVC teams adopting MP technology.
摘要：
背景：机器灌注（MP）用于扩大供体库并改善肝移植（LT）结果。尽管临床试验结果最佳，在低/中等容量活动（LVC）的中心，实际的MP益处仍在确定中。
方法：关于MPforLT的在线调查，分发给全球LT中心代表。感兴趣的变量包括物流，技术细节,和结果。将反应者分为高容量中心（HVC）（>60LTs/年）和LVC，并比较结果。
结果：包括67个中心，36个HVC和31个LVC。MP的显着差异：（I）存在既定计划（80.6％与41.9%；p=0.02)，(II)有专门的灌注师(58.3%vs.22.6%；p=0.006)，(III)持续时间(>4h：47.2%vs.16.1%；p=0.01），(四)常规使用(20%-40%vs.5%-20%；p=0.002），（V）移植物利用率（>50％：75％vs.51.6%；p=0.009)，(VI)90天患者生存率(90%-100%vs.50%-90%；p=0.001)和(VII)主观感知效益(总是与仅在选定的ECD中；p=0.009）。发现适应症的一致性，type,生存能力测试，移植打捞,90天移植物丢失，和重大并发症。
结论：这项研究捕获了MP在现实世界LT实践中的图片。LVC和HVC在物流方面出现了显著的差距，利用率，和结果。为了缩小这个差距，应努力更有效地提供专门的支持，对采用MP技术的LVC团队进行培训和指导。
方法：关于MPforLT的在线调查，分发给全球LT中心代表。感兴趣的变量包括物流，技术细节,和结果。将反应者分为高容量中心（HVC）（>60LTs/年）和LVC，并比较结果。
结果：包括67个中心，36个HVC和31个LVC。MP的显着差异：（I）存在既定计划（80.6％与41.9%；p=0.02)，(II)有专门的灌注师(58.3%vs.22.6%；p=0.006)，(III)持续时间(>4h：47.2%vs.16.1%；p=0.01），(四)常规使用(20%-40%vs.5%-20%；p=0.002），（V）移植物利用率（>50％：75％vs.51.6%；p=0.009)，(VI)90天患者生存率(90%-100%vs.50%-90%；p=0.001)和(VII)主观感知效益(总是与仅在选定的ECD中；p=0.009）。发现适应症的一致性，type,生存能力测试，移植打捞,90天移植物丢失，和重大并发症。
结论：这项研究捕获了MP在现实世界LT实践中的图片。LVC和HVC在物流方面出现了显著的差距，利用率，和结果。为了缩小这个差距，应努力更有效地提供专门的支持，对采用MP技术的LVC团队进行培训和指导。
