Combining NRP and NMP vs NMP Alone in DCD Liver Transplantation

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Trenches in Transplant Surgery

Sabin Subedi

45 episodes

6 days ago

Step into the forefront of abdominal transplant surgery — where innovation meets ongoing complexity. Machine perfusion and normothermic regional perfusion (NRP) are reshaping organ preservation and donor utilization, with growing evidence that these technologies improve graft assessment and early outcomes. Yet reviews continue to highlight key challenges — ischemia–reperfusion injury, biliary complications in DCD grafts, and the logistical demands of perfusion platforms. Despite these hurdles, transplantation is shifting from an urgent, unpredictable field toward a planned, daytime specialty. The next horizon, underscored by recent expert reviews, is true organ banking — bringing us closer to on-demand, schedulable transplantation.

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Medicine

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Combining NRP and NMP vs NMP Alone in DCD Liver Transplantation

Trenches in Transplant Surgery

28 minutes 18 seconds

3 months ago

Combining NRP and NMP vs NMP Alone in DCD Liver Transplantation

Combining Normothermic Regional Perfusion (NRP) with Normothermic Machine Perfusion (NMP) in DCD liver transplantation offers synergistic benefits over NMP alone by providing both early in-situ resuscitation and ex-situ viability assessment. While NMP alone improves early graft function and logistics, it does not fully prevent ischemic cholangiopathy (IC); in contrast, NRP—by rapidly restoring oxygenated blood flow in the donor—virtually eliminates IC and significantly enhances biliary outcomes. Together, NRP+NMP yields superior graft survival, lower complication rates, and expanded use of marginal livers, including those from elderly donors or with long transport times. Though more resource-intensive, this sequential approach maximizes graft quality, minimizes cold ischemia, and enables flexible, elective transplantation with a near-complete reduction in IC, positioning it as the most protective and comprehensive strategy currently available.