AUTHOR=Magini Giulia , Wozniak Hannah , Schafer Antonia , Moeckli Beat , Banz Vanessa , Vionnet Julien , Deibel Ansgar , Oberholzer Jose , Tinguely Pascale , Goossens Nicolas , Peloso Andrea , Korner Mirjam , Immer Franz , De Carlis Riccardo , Toso Christian , Assouline Benjamin , Bendjelid Karim , Compagnon Philippe , Giraud Raphael 
  
TITLE=Abdominal normothermic regional perfusion is associated with improved graft survival in liver transplantation from circulatory death donors
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.16004
  
DOI=10.3389/ti.2026.16004
  
ISSN=1432-2277
  
ABSTRACT=Advanced preservation strategies are increasingly used in liver transplantation following donation after circulatory death (DCD). This nationwide observational study evaluated the association between abdominal normothermic regional perfusion (A-NRP) and 1-year graft survival in a Swiss cohort of 254 DCD liver transplants performed between 2017 and 2023. Recovery strategies compared included A-NRP and super-rapid recovery (SRR), both predominantly followed by end-ischemic hypothermic oxygenated perfusion (HOPE). Primary endpoint was 1-year graft loss; secondary endpoints included 1-year patient mortality, primary non-function, non-anastomotic strictures (NAS), biliary and vascular complications and need for re-transplantation. Overall, 53 grafts were retrieved using A-NRP (71% followed by HOPE) and 201 using SRR (90% followed by HOPE). Compared with SRR, A-NRP grafts demonstrated lower rates of graft loss (5.7% vs. 24.6%), 1-year mortality (1.9% vs. 13.3%), NAS (5.7% vs. 20.5%), other biliary complications (1.9% vs. 12.6%) and re-transplantation (3.8% vs. 12.8%). In multivariable Cox regression analysis, A-NRP was associated with lower risk of 1-year graft loss and patient mortality after adjustment for UK DCD risk category and HOPE use. These findings suggest that A-NRP is associated with improved outcomes. Further studies are needed to define the role of ex-situ perfusion after A-NRP in optimizing results.