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Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2025; 15(4): 104111
Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.104111
Utilization of normothermic machine perfusion in pediatric liver transplantation: Three case reports
Christine S Hwang, Andrew D Shubin, Amal Aqul, Jorge A Sanchez-Vivaldi, Kayla D Colvill, Malcolm P MacConmara, Yash Kadakia, Christine Johansen, Jigesh A Shah, Steven I Hanish, Parsia A Vagefi, Madhukar S Patel
Christine S Hwang, Andrew D Shubin, Christine Johansen, Jigesh A Shah, Parsia A Vagefi, Madhukar S Patel, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Christine S Hwang, Andrew D Shubin, Christine Johansen, Jigesh A Shah, Parsia A Vagefi, Madhukar S Patel, Division of Pediatric Transplantation, Children’s Medical Center, Dallas, TX 75235, United States
Amal Aqul, Division of Pediatric Gastroenterology, Children’s Medical Center, Dallas, TX 75235, United States
Jorge A Sanchez-Vivaldi, Programa Transplante Hígado Adulto Y Pedíatrico, Auxilio Mutuo, San Juan, PR 00917, United States
Kayla D Colvill, Division of Transplant Surgery, Texas Health Resources-Fort Worth, Dallas, TX 76104, United States
Malcolm P MacConmara, Abdominal Transplant, Transmedics inc, Andover, MA 01810, United States
Yash Kadakia, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States
Steven I Hanish, Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
Author contributions: Hwang CS contributed to gathered, organized, and analyzed the data; Shubin AD, Aqul A, Sanchez-Vivaldi JA contributed to Particiapted in writing and reviewing the manuscript; Colvill K, Shah JA, Hanish S, and Vagefi PA contributed to Participated in reviewing the manuscript; MacConmara M contributed to participated in gathering, organizing, and performing data analysis; Kadakia Y contributed to participated in analyzing data; Patel MS contributed to participated in gathering, organizing, and performing data analysis; Hwang CS, MacConmara M, Kadakia Y, Johansen C, and Patel MS contributed to writing the manuscript.
Informed consent statement: All patients and families gave consent to have their information be part of this manuscript.
Conflict-of-interest statement: Madhukar S. Patel is supported as the Dedman Scholar of Clinical Care at UT Southwestern Medical Center. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. All authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christine S Hwang, MD, Associate Professor, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd., Dallas, TX 75390, United States. christine.hwang@utsouthwestern.edu
Received: December 13, 2024
Revised: April 13, 2025
Accepted: May 10, 2025
Published online: December 18, 2025
Processing time: 341 Days and 19.3 Hours
Abstract
BACKGROUND

Normothermic machine perfusion (NMP) utilizing OCS Liver is becoming increasingly common in adult liver transplantation (LT), but not in pediatric transplantation. OCS Liver has been shown to decrease post-reperfusion syndrome and early allograft dysfunction after transplantation. We describe the first case series of three pediatric patients who received a liver transplant using livers preserved with NMP.

CASE SUMMARY

Three pediatric patients, all with different etiologies of liver disease, were successfully transplanted with livers preserved with NMP. All patients are currently doing well with follow-ups of 7 to 16 months post-transplant.

CONCLUSION

The use of OCS Liver in pediatric LT is feasible and can be performed even in the sickest recipients with excellent outcomes. Utilization of OCS Liver can optimize donor and recipient factors to allow for optimal outcomes.

Keywords: Liver transplantation; Normothermic machine perfusion; Pediatrics; Case report

Core Tip: We report the first published use of normothermic machine perfusion in pediatric liver transplant recipients.