*Purpose: Normothermic liver preservation (NMP) has become a clinically established tool to preserve livers in a near-physiological environment. Currently, decreasing lactate and physiological pH-levels are the main parameters used as a decision-making aid to transplant or not to transplant a liver. Our aim was to analyze markers in the perfusate which can be analyzed during the process of perfusion routinely and their impact on initial liver function (ILF) post-transplant.

*Methods: Perfusates from all livers preserved on a normothermic machine perfusion (NMP) device were collected throughout the perfusion period at four different time points. Delta values were calculated and correlated with the occurrence of early allograft dysfunction (EAD) after transplantation according to the definition by Olthoff et al. A p-value <0.05 was considered significant.

*Results: Between February 2018-October 2019, 42 livers from deceased donors were transplanted after NMP. Four livers came from donors after circulatory death (DCD), twenty-seven (64.3%) from expanded criteria donors (ECD). The mean±SD recipient and donor age was 60.1±10.2 and 56.3±15.7years. Cold ischemia time (CIT) was 6.4±2.29 hours; overall preservation time was 21.4±7.1 hours. EAD occurred in 12/42 (28.6%) patients. Overall median peak-AST was 950U/l (163-6916). Recipient and donor demographics, as well as ischemia and anhepatic times were not significantly different between patients with ILF and EAD; neither were they different between patients developing peak-AST-values higher or lower than the median. Significant difference between EAD and ILF were delta-values of AST, ALT and GGT, LDH; Repeated measures ANOVA showed the higher the transaminases and LDH at the end of perfusion, the more likely the occurrence of EAD and high peak-AST-levels; p<0.05. EAD was more likely to occur in livers that showed a lower pH-level at the beginning of NMP compared to livers with ILF p=0.021.

*Conclusions: It is possible to test viability using perfusate parameters over time. Besides the clinical use of lactate, we need to consider the increase of transaminases and LDH over time as well as lower pH levels early after perfusion start as important factors correlating with EAD. Future comparisons with perfusate levels of discarded NMP livers will shed more light into viability assessment of livers.

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