Photo Credit: SvetaZi
The following is a summary of “Machine Perfusion or Straight to Transplant? Predictive Value of Flavin Mononucleotide Levels in Flush Solution of Human Liver Allograft,” published in the October 2024 issue of Surgery by Ali et al.
Static cold storage of liver grafts causes hypoxia, impairing mitochondrial function and Flavin Mononucleotide (FMN) release upon reperfusion.
Researchers conducted a prospective study to evaluate the predictive value of FMN levels in the flush solution of liver allografts on post-transplant outcomes.
They enrolled 62 recipients of whole liver grafts from donation after brain death (n=50) and circulatory death donors (n=12) (June 2022 to July 2023). The FMN concentrations were measured in flush solutions on the back table, and receiver operating characteristic (ROC) curve analysis identified an FMN level cut-off for graft survival.
The results showed that FMN level was associated with graft survival, with an area-under-the-curve (AUC) of 0.858 (95%CI: 0.754-0.963, P<0.001), outperforming the donor risk index (AUC 0.571, 95%CI: 0.227-0.915, P=0.686). The study cohort was divided into low-FMN (<37.5 ng/mL, n=40) and high-FMN groups (≥37.5 ng/mL, n=22). The low-FMN group had superior 1-year graft survival compared with the high-FMN group (100% vs. 77%, P=0.003). Levels of transaminases within 7 days post-transplant were significantly higher in the high-FMN group (P=0.003). The high-FMN group developed acute rejections more frequently (41% vs. 15%, P=0.023) and experienced early allograft dysfunction at a higher rate (50% vs. 20%, P=0.014). The median comprehensive complication index in the high-FMN group was significantly higher, measured at 54 (interquartile range, 40-78) compared to 42 (IQR, 28-52) in the low-FMN group (P=0.017).
They concluded that FMN levels in the flush solution of donor livers served as a valid biomarker for predicting post-transplant outcomes, suggesting that liver grafts with high FMN levels may benefit from machine perfusion.
