Transforming Transplant Oversight: Enhancing Combined Cardiothoracic Surgery and Liver Transplantation with Normothermic Machine Perfusion

Background. Simultaneous cardiothoracic surgery and liver transplantation (LT) is a high-risk procedure associated with high mortality and morbidity rates. The use of normothermic machine perfusion (NMP) allows graft quality enhancement, assessment of liver viability, and logistics optimization, expanding the donor pool and reducing organ discard rate. We share our institution's experience with simultaneous cardiothoracic surgery and LT, using NMP for liver graft preservation and viability assessment. Methods. Data was retrospectively collected from 14 patients who underwent simultaneous cardiothoracic surgery and LT with NMP for liver graft preservation from October 2022 to August 2023. Data was divided into 3 groups: combined heart transplant and LT, lungs transplant and LT, and nontransplant cardiothoracic surgery and LT. Results. All liver grafts were from brain-dead donors. Median machine perfusion times were 211 min (range, 186-242 min), 222 min (range, 211-246 min), and 627 min (range, 180-1003 min) across the 3 groups, respectively. Postreperfusion syndrome occurred in 3 patients (21%), with 5 (36%) readmitted within 30 d because of complications. Biliary complications developed in 5 patients (36%), and 2 (14%) experienced acute liver rejection within 90 d postsurgery. No mortality was recorded during the median 18-mo follow-up. Conclusions. NMP serves as a safe and valuable tool for patients in need of simultaneous cardiothoracic surgery and LT, potentially broadening the scope of eligibility for these complex procedures.