Avoiding Recooling After Normothermic Machine Perfusion in Liver Transplantation

Avoiding Recooling After Normothermic Machine Perfusion in Liver Transplantation: a Multicenter, Parallel-group, Open-label, Non-inferiority Randomized Controlled Trial

The ARANMP-LT study is a multicenter, open-label, randomized, parallel-group, non-inferiority clinical trial designed to evaluate whether avoiding graft recooling after normothermic machine perfusion (NMP) improves early outcomes following liver transplantation. Although graft recooling before implantation is common practice, experimental and preliminary clinical evidence suggests that abrupt temperature changes may contribute to ischemia-reperfusion injury.

Adult recipients of deceased-donor liver grafts preserved with NMP or sequential hypothermic-normothermic machine perfusion (SHNMP) will be randomized in a 1:1 ratio to either standard graft implantation with recooling using cold preservation solution (control group) or implantation without recooling using a room-temperature 5% albumin flush immediately before reperfusion (intervention group).

The primary objective is to compare the incidence of Early Allograft Dysfunction (EAD), defined according to the Olthoff criteria, between the two treatment groups. Secondary objectives include evaluation of histopathological ischemia-reperfusion injury using the Suzuki score, vascular and biliary complications, primary non-function, post-reperfusion syndrome, patient and graft survival, length of intensive care unit and hospital stay, perioperative transfusion requirements, and safety outcomes. A total of 170 participants will be enrolled across multiple Italian liver transplant centers and followed for 90 days after transplantation.

Inclusion Criteria:

• Age ≥18 years.
• Listed for primary liver transplantation at the participating institution.
• Assigned a liver graft preserved with normothermic machine perfusion or sequential hypothermic- normothermic machine perfusion (SHNMP).
• Signed and dated informed consent prior study inclusion.

Exclusion Criteria:

• Pediatric patients (age < 18 years)
• Patients undergoing re-transplantation (history of previous liver transplantation)
• Patients with acute liver failure
• Patients undergoing multi-organ transplantation (e.g., liver-kidney, liver-heart)
• Temporarily unconscious patients
• Patients unable to freely express consent.