First report of successful transplantation of a pediatric donor liver graft after hypothermic machine perfusion

Maureen J.M. Werner, Otto B. van Leeuwen, Iris E.M. de Jong, Frank A.J.A. Bodewes, Masato Fujiyoshi, Olaf C. Luhker, René Scheenstra, Yvonne de Vries, Ruben H.J. de Kleine, Robert J. Porte*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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One of the main limiting factors in pediatric liver transplantation is donor availability. For adults, DCD liver grafts are increasingly used to expand the donor pool. To improve outcome after DCD liver transplantation, ex situ machine perfusion is used as an alternative organ preservation strategy, with the supplemental value of providing oxygen to the graft during preservation. We here report the first successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion. The full-size liver graft was derived from a 13-year-old, female DCD donor and was end-ischemic pretreated with dual hypothermic oxygenated machine perfusion. Arterial and portal pressures were set at 18 and 4 mm Hg, slightly lower than protocolized settings for adult livers. During 2 hours of machine perfusion, portal and arterial flows increased from 100 to 210 mL/min and 30 to 63 mL/min, respectively. The pretreated liver graft was implanted in a 16-year-old girl with progressive familial intrahepatic cholestasis type 2. Postoperative AST, ALT, and prothrombin time normalized within a week. The recipient quickly recovered and was discharged from the hospital after 18 days. One year after transplantation, she is in excellent condition with a completely normal liver function and histology. This case is the first report of successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion and illustrates the potential role of ex situ machine perfusion in expanding the donor pool and improving outcome after pediatric liver transplantation.

Original languageEnglish
Article numbere13362
Number of pages5
JournalPediatric transplantation
Issue number3
Publication statusPublished - 1-May-2019


  • donation after circulatory death
  • hypothermic oxygenated machine perfusion
  • pediatric liver transplantation

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