The imbalance between organ supply and demand continues to limit the broader benefits of organ transplantation. Machine perfusion (MP) may increase the supply of donor livers by expanding the use of extended-criteria donors. Using the United Network for Organ Sharing/Organ Procurement and Transplantation Network and the Standard Transplant Analysis and Research dataset, we reviewed the effect of MP implementation on the behavior of transplant centers. We identified 15 high-utilizing MP centers that were matched to suitable controls based on volume and geographical proximity. We conducted a differences-in-differences analysis using linear regression to estimate the impact of MP adoption on the transplant centers’ donor utilization. We found a significant increase in cold ischemia time and organs with donor warm ischemia time over 30 minutes ( < .05). After removing one outlier center, the analysis showed that these centers through MP accepted overall more donation after circulatory death donors, donation after circulatory death donors over 50 years old, donors with macrovesicular steatosis greater than 30% on liver biopsy, and donor warm ischemia time over 30 minutes ( < .05). MP has allowed centers to expand their use of extended-criteria donors beyond traditional cutoffs and to increase patient access to liver transplantation.

中文翻译：

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肝机灌注技术：扩大供体库，提高肝移植的可及性

器官供需之间的不平衡继续限制器官移植的更广泛益处。机器灌注（MP）可以通过扩大扩展标准供体的使用来增加供体肝脏的供应。使用器官共享联合网络/器官采购和移植网络以及标准移植分析和研究数据集，我们回顾了 MP 实施对移植中心行为的影响。我们确定了 15 个高利用率的 MP 中心，根据数量和地理接近程度与适当的控制相匹配。我们使用线性回归进行了双重差异分析，以估计 MP 采用对移植中心捐赠者利用率的影响。我们发现供体热缺血时间超过 30 分钟 (< .05) 时冷缺血时间和器官显着增加。剔除1个离群中心后，分析显示，这些中心通过MP接受的捐献总体上较多的是循环死亡捐献者、50岁以上循环死亡捐献者、肝活检大泡脂肪变性大于30%的捐献者以及捐献者热缺血时间超过 30 分钟 (< .05)。 MP 允许中心扩大对扩展标准供体的使用，超越传统的限制，并增加患者接受肝移植的机会。