Deceased Donor Liver Procurement and Preservation Techniques: What is Cost-effective? A Systematic Review.
Cox, D. R. A., et al.Transplantation. 2026 Feb 1;110(2):e342-e355.
Aims
The main aim of the study was to evaluate whether machine perfusion techniques are cost-effective alternatives to static cold storage in deceased donor liver procurement and preservation prior to transplantation.
Interventions
A literature search was performed on MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Study selection and data extracted were performed independently by two reviewers. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) guidelines was used to assess the methodological quality of the included studies.
Participants
14 studies were included in the review.
Outcomes
Pretransplantation costs; perfusion costs; posttransplantation costs based on clinical and “virtual model” data; analysis based on statistical modeling for hypothermic oxygenated liver perfusion (HOPE), normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP); and posttransplant costs of NMP in a real-world patient cohort.
Follow-up
N/A
CET Conclusions
This is an interesting and well conducted systematic review, with a broad search. The limitation to the last 10 years is not unreasonable given the changes in the available technology. Waiting time for liver transplant decreased at two US centres after the introduction of NMP.The reduction in median healthcare that resulted was significant. A large decrease in healthcare cost was also seen in a Canadian setting where organ utilisation increased significantly. In fact, all but one of the included studies found machine perfusion to be cost-effective. The investment and running costs for NMP are substantial, but within the limitations of this study there does appear to be financial benefits to the strategy as well as clinical benefits from increased organ utilisation and reduced waiting times.
Trial registration
N/A