*Purpose: Normothermic Ex-vivo Liver Perfusion (NELP) of livers shows promising results in overcoming injuries that occur in deceased donor liver transplantation. The effect of NELP on discarded marginal donor livers is still under investigation. We investigated the dynamic changes of liver function parameters of discarded human livers during NELP and compared the treatment with early functional outcomes of routine orthotopic liver transplantation.

*Methods: From November 2017 to November 2018, discarded human livers were acquired from our local organ procurement center. Livers were prepared for NELP treatment using a custom perfusion system. Livers were perfused for 6 hours, and perfusate samples were collected hourly. Samples were tested for several biochemical parameters to assess liver function and damage. The liver function prior to organ procurement was acquired from UNOS online database. We retrospectively reviewed OLT cases from our institutional database, all DCD OLT cases and randomly selected DBD OLT cases; the donor liver function and early post-transplant liver function data were collected and compared with NELP-treated discarded human livers. The data were analyzed and illustrated in Graphpad Prism 5.

*Results: 10 discarded human livers were collected and underwent 6 hours of NELP. Out of a total 57 OLT cases in the same time period, 6 DCD cases and 10 DBD cases were randomly selected to proportionally match the NELP group. There were no significant differences in donor liver function parameters. Liver function parameters of NELP group at 1 hour and 6 hour (ALT: 1111,85-8775(median, range) U/L vs. 1565,189-10386 U/L; p = 0.46) are higher than OLT group at post-operative timepoints (ALT: 743,155-5908 U/L vs. 699,123-5118 U/L; p = 0.11), yet without statistical significance (NELP vs. OLT, ALT: 1 hour p = 0.24, 6 hour p = 0.15). Dynamic changes of liver function during NELP for discarded livers demonstrated different baseline and progression profiles, suggesting a differentiation of liver function via NELP treatment (2-way ANOVA, ALT: p = 0.006, AST: p = 0.015).

*Conclusions: These results suggest that NELP does not outright recover marginal livers on its own, but rather, differentiates recoverable livers by their stabilized functional status during the hours of normothermic perfusion. Further data collection and investigations are warranted to produce more consistent results.

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