TABLE 4.
Key considerations on introduction of MP in the hospital setting based on HB-HTA.
| Dimension | Information |
|---|---|
| Clinical | Available |
| • Current MP technology is safe and associated with equal-to- superior graft and patient short-term survival versus SCS | |
| • Main advantages of MP are a reduced risk for IRI, EAD, and IBC, and a reduced graft discard rate | |
| • MP facilitates implementation of a DCD LT program, especially for type-2 DCD grafts | |
| Needed | |
| • Better identification of ECD DBD grafts to treat with MP | |
| • Better identification of recipient populations to be treated with MP | |
| • Long-term data in transplant populations exposed to MP | |
| Economic(al) | Available |
| • MP is not economically neutral | |
| • MP is projected to increase costs of LT in the hospital setting | |
| • HT advancements are projected to increase MP-related costs in the near future (i.e., graft reconditioning) | |
| Needed | |
| • Cost-effective and cost-utility analyses on long-term recipients of MP-facilitated LT | |
| • Best strategies to neutralize increased costs of MP (i.e., introduction of ad hoc DRG, reimbursement of marginal gains achieved from increased proportion of transplants, etc.) | |
| Ethical | Available |
| • Limited information is currently available and consists of reports of numerically low MP-related adverse events | |
| Needed | |
| • Patient acceptance has to be investigated | |
| • Strategies to allow for equitable access to MP across LT centers should be identified | |
| • Potential patient harm from non-implementation of MP-facilitated transplantation should be investigated with simulation models (i.e., competitive risk analysis) | |
| Social | Available |
| • None | |
| Needed | |
| • Patient quality of life has to be investigated in the setting of MP-facilitated LT | |
| • Time in hospital/patient burden should be the focus of future studies | |
| Organizational | Available |
| • None | |
| Needed | |
| • Future studies should focus on staff training and learning curves, equipment availability with regard to comparative analysis of the different commercially available devices, and on the impact of resource constraints (staff and/or financial) on implementation of an MP-facilitated LT program | |
| Human factors | Available |
| • None | |
| Needed | |
| • As technology evolves, acceptance/acceptability of novel devices and information on usability/ease of use has to be provided |
Note. DCD, donation after circulatory death; DRG, disease-related group; EAD. Early allograft dysfunction; ECD, extended criteria donors; HB-HTA, hospital-based HTA; HT, health technology; HTA, health technology assessment; IBC, ischemic biliary complications; LT, liver transplantation; MP, machine perfusion; SCS, static cold storage.