Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region (''orphan livers''). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for EndStage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-88C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p ¼ 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p ¼ NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p ¼ 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 AE 10.9 vs. 20.14 AE 11.12 days in the SCS group, p ¼ 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.

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