Normothermic Regional Perfusion in Donation After Circulatory Death for Liver Transplantation: A Narrative Review

Normothermic regional perfusion (NRP) is an emerging procurement technique intended to increase the quantity and quality of allografts available for transplantation. The purpose of this review is to summarize the current international experience with NRP for donation after circulatory death (DCD) liver donors and its impact on liver transplantation outcomes.

The use of NRP for DCD donors is increasing and has become standard or mandatory practice in many countries. DCD liver graft utilization is significantly higher with NRP use compared to static cold storage (SCS). Recipients experience significantly fewer episodes of primary non-function (PNF), early allograft dysfunction (EAD), and ischemic-type biliary lesions (ITBL) with NRP compared to SCS.

NRP may increase the utilization of available DCD liver grafts and contribute to reducing the organ shortage. Further studies are needed to understand the extent of impact on utilization and recipient outcomes as NRP is employed more broadly.