{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:23:00Z","timestamp":1783441380003,"version":"3.54.6"},"reference-count":33,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Normothermic machine perfusion (NMP) is increasingly being used to improve organ utilization in liver transplantation (LT). However, its non-physiological perfusion setting may cause focal hepatic hypoperfusion (FHH), which remains insufficiently characterized in terms of its incidence, risk factors, and clinical impact. Methods: Data on liver grafts that underwent NMP prior to LT at the Department of General, Visceral, and Transplant Surgery, University Hospital M\u00fcnster, between October 2019 and August 2024 were retrospectively analyzed. Recipients who underwent contrast-enhanced computed tomography within 30 days post-LT were included. The primary outcomes were the Comprehensive Complication Index (CCI) and overall graft survival rate. Ninety-one patients met the inclusion criteria and were stratified according to the presence of FHH in the FHH+ (n = 27) and FHH- (n = 64) groups. Results: FHH was detected in 29.7% of the grafts. Higher graft weight was the only independent predictor of FHH. In addition, graft weight correlated with the extent of FHH (\u03c4 = 0.40, p &lt; 0.001). FHH did not affect graft or patient survival but was associated with higher CCI scores (p = 0.001) and prolonged intensive care unit length of stay (p = 0.028). Conclusions: FHH is a common radiological finding after NMP. Although it does not affect graft loss, its association with a higher complication burden warrants further attention. Whether avoiding NMP in very heavy grafts could reduce the incidence of FHH remains to be determined.<\/jats:p>","DOI":"10.3390\/bioengineering13070729","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:02:56Z","timestamp":1783436576000},"page":"729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Focal Hepatic Hypoperfusion After Normothermic Machine Perfusion of Liver Grafts Is Associated with a Higher Comprehensive Complication Index"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2127-3118","authenticated-orcid":false,"given":"Felicia","family":"Kneifel","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-3128","authenticated-orcid":false,"given":"Felix","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing Wen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1650-2705","authenticated-orcid":false,"given":"Carsten","family":"Szardenings","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kubasch","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Riegel","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haluk","family":"Morg\u00fcl","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Flammang","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5482-7458","authenticated-orcid":false,"given":"Shadi","family":"Katou","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Pascher","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Houben","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Transplant Organ Recovery Center (TORC), University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.transproceed.2020.06.038","article-title":"Allograft Necrosis in Liver Biopsy Is Predictive for Organ Outcome and Patient Survival","volume":"53","author":"Zhang","year":"2021","journal-title":"Transplant. Proc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1097\/TP.0000000000004970","article-title":"Localized Liver Injury during Normothermic Ex Situ Liver Perfusion Has No Impact on Short-Term Liver Transplant Outcomes","volume":"108","author":"Martin","year":"2024","journal-title":"Transplantation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ajt.2024.12.048","article-title":"Factors Associated with Liver Cradle Compression Effect Following Normothermic Machine Perfusion","volume":"25","author":"Subramanian","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.jhep.2023.05.027","article-title":"Machine Perfusion Techniques for Liver Transplantation\u2014A Meta-Analysis of the First Seven Randomized-Controlled Trials","volume":"79","author":"Parente","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3390\/biomedicines9020161","article-title":"Viability Assessment in Liver Transplantation-What Is the Impact of Dynamic Organ Preservation?","volume":"9","author":"Panconesi","year":"2021","journal-title":"Biomedicines"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1002\/lt.26092","article-title":"The Emerging Role of Viability Testing during Liver Machine Perfusion","volume":"28","author":"Bruggenwirth","year":"2022","journal-title":"Liver Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1177\/039139889301601010","article-title":"Extracorporeal Liver Perfusion: Applications of an Improved Model for Experimental Studies of the Liver","volume":"16","author":"Neuhaus","year":"1993","journal-title":"Int. J. Artif. Organs"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"981","DOI":"10.2214\/ajr.156.5.2017964","article-title":"Subcapsular Hepatic Necrosis in Liver Transplantation: Ct Appearance","volume":"156","author":"Abecassis","year":"1991","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1002\/hep.1840060428","article-title":"Subcapsular Hepatic Necrosis in Orthotopic Liver Allografts","volume":"6","author":"Russo","year":"1986","journal-title":"Hepatology"},{"key":"ref_10","first-page":"657","article-title":"Improved Extracorporeal Hepatic Assist Using Intermittent External Pressure on the Liver","volume":"36","author":"Velasquez","year":"1970","journal-title":"Am. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41587-019-0374-x","article-title":"An Integrated Perfusion Machine Preserves Injured Human Livers for 1 Week","volume":"38","author":"Eshmuminov","year":"2020","journal-title":"Nat. Biotechnol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1097\/TP.0000000000003462","article-title":"Machine Perfusion-Leaving Its Mark on Liver Transplantation","volume":"105","author":"Richards","year":"2021","journal-title":"Transplantation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S97","DOI":"10.1016\/j.ajt.2025.07.203","article-title":"Donor Liver Weight in Normothermic Ex Situ Machine Perfusion: Do Large Livers Perform Worse?","volume":"25","author":"Goodnight","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e70116","DOI":"10.1111\/liv.70116","article-title":"Donor-Related Risk Factors for Normothermic Machine Perfusion in Liver Transplantation: A Meta-Analysis","volume":"45","author":"Franssen","year":"2025","journal-title":"Liver Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.surg.2024.05.025","article-title":"Viability Assessment and Transplantation of Extended Criteria Donor Liver Grafts Using Normothermic Machine Perfusion","volume":"176","author":"Vogel","year":"2024","journal-title":"Surgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3833","DOI":"10.1007\/s00423-022-02611-8","article-title":"Ex Situ Arterial Reconstruction Prior Normothermic Machine Perfusion of Liver Grafts","volume":"407","author":"Becker","year":"2022","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1111\/j.1600-6143.2012.04195.x","article-title":"Liver European, Association Intestine Transplant, and Committee Eurotransplant Liver Intestine Advisory. The Eurotransplant Donor Risk Index in Liver Transplantation: Et-Dri","volume":"12","author":"Braat","year":"2012","journal-title":"Am. J. Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1056\/NEJM198710223171717","article-title":"Simplified Calculation of Body-Surface Area","volume":"317","author":"Mosteller","year":"1987","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/S0041-1345(03)00482-2","article-title":"A Simple New Formula to Assess Liver Weight","volume":"35","author":"Yoshizumi","year":"2003","journal-title":"Transplant. Proc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","article-title":"The Comprehensive Complication Index: A Novel Continuous Scale to Measure Surgical Morbidity","volume":"258","author":"Slankamenac","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1002\/lt.22091","article-title":"Validation of a Current Definition of Early Allograft Dysfunction in Liver Transplant Recipients and Analysis of Risk Factors","volume":"16","author":"Olthoff","year":"2010","journal-title":"Liver Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for Rating Diagnostic Tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1038\/s41587-020-0720-z","article-title":"Viability Criteria Assessment during Liver Machine Perfusion","volume":"38","author":"Bruggenwirth","year":"2020","journal-title":"Nat. Biotechnol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1016\/j.ajt.2024.12.227","article-title":"Cradle Compression during Normothermic Machine Perfusion in Liver Transplantation: Incidence and Impact on Postoperative Outcomes","volume":"25","author":"Imai","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1002\/lt.24461","article-title":"Liver Transplantation in Germany","volume":"22","author":"Tacke","year":"2016","journal-title":"Liver Transplant."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1016\/j.transproceed.2019.03.045","article-title":"Effect of Duration of Intensive Care Unit Stay on Outcomes of Adult Living Donor Liver Transplant Recipients","volume":"51","author":"Ali","year":"2019","journal-title":"Transplant. Proc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcrc.2016.12.006","article-title":"Circadian Disruption of Icu Patients: A Review of Pathways, Expression, and Interventions","volume":"38","author":"Korompeli","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S784","DOI":"10.1016\/j.hpb.2018.06.2369","article-title":"Comprehensive Complication Index Measure at Moment of Post-Liver Transplant Discharge Well Predicts Long-Term Survival","volume":"20","author":"Melandro","year":"2018","journal-title":"HPB"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s13304-020-00878-4","article-title":"The Role of the Comprehensive Complication Index for the Prediction of Survival after Liver Transplantation","volume":"73","author":"Lai","year":"2021","journal-title":"Updates Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"336","DOI":"10.4240\/wjgs.v12.i8.336","article-title":"Influence of Postoperative Complications on Long-Term Survival in Liver Transplant Patients","volume":"12","author":"Castanedo","year":"2020","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.5005\/jp-journals-10018-1361","article-title":"Outcomes after Liver Transplantation with Steatotic Grafts: Redefining Acceptable Cutoffs for Steatotic Grafts","volume":"12","author":"Da","year":"2022","journal-title":"Euroasian J. Hepato-Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Patrono, D., De Stefano, N., Vissio, E., Apostu, A.L., Petronio, N., Vitelli, G., Catalano, G., Rizza, G., Catalano, S., and Colli, F. (2023). How to Preserve Steatotic Liver Grafts for Transplantation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12123982"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Abbas, S.H., Ceresa, C.D.L., and Pollok, J.M. (2024). Steatotic Donor Transplant Livers: Preservation Strategies to Mitigate against Ischaemia-Reperfusion Injury. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094648"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/7\/729\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:39:39Z","timestamp":1783438779000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/7\/729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["bioengineering13070729"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13070729","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}