Abstract
Background
Normothermic ex situ liver perfusion (NESLiP) has the potential to increase organ utilisation.
Radiological evidence of localised liver injury due to compression at the time of NESLiP,
termed cradle compression, is a recognised phenomenon but is poorly characterised.
Methods
A retrospective analysis of a prospectively collected database was performed of
transplanted livers that underwent NESLiP and subsequently had a CT performed within the
first 14 days post-transplant. The primary study outcome was 1 year graft survival.
Results
70 (63%) livers were included in the analysis. Radiological evidence of cradle compression
was observed in 21/70 (30%). There was no difference in rate of cradle compression
between DCD and DBD donors (p = 0.37) or with duration of NESLiP. Univariate analysis
demonstrated younger (AUROC 0.68, p 0.008 (95% CI 0.55-0.82)) and heavier (AUROC 0.80,
p <0.001 (95% CI 0.69-0.91)) livers to be at risk of cradle compression. Only liver weight was
associated with cradle compression on multivariate analysis (OR 1.003, p = 0.005 (95% CI
1.001-1.005). There was no difference in 1 year graft-survival (16/17 (94.1%) vs 44/48
(91.6%) OR 0.69, p = 0.75 95% CI 0.07-6.62).
Conclusions
This is the first study assessing the impact of cradle compression on outcome. We have
identified increased donor liver weight and younger age as risk factors for the development
of this phenomenon. Increasing utilisation of NESLiP will result in the increased incidence of
cradle compression but the apparent absence of long-term sequelae is reassuring. Routine
post operative axial imaging may be warranted
