Reply: Acute rejection after transplantation of machine perfused livers—We have barely scratched the surface

Abstract

We thank Liang et al [1] and Neil et al [2] for their letters regarding our recent meta-analysis on acute cellular rejection after liver transplantation with dynamic preservation versus static cold storage. [3] We appreciate the literature review conducted by Liang et al [1] although the mentioned studies were either excluded from our meta-analysis because they did not meet our inclusion criteria or were published after our literature search had already been completed. The authors are correct that Nasralla et al [4] state in their protocol that they will record biopsy-proven acute cellular rejection as a safety outcome; however, Extended Table 6, which summarizes all adverse events, only mentions "rejection".We commend the Birmingham group for their interesting work on retransplantation with "suboptimal liver grafts" after normothermic machine perfusion (NMP). [5] Hann and colleagues demonstrated an increased T-cell-mediated rejection after NMP, which poses relevant questions on the impact of normothermic preservation on immunogenicity. We agree that the DATA AVAILABILITYThe data, code, and other materials are available from the corresponding author upon reasonable request.