Introduction:  Preservation of deceased donor livers with normothermic machine perfusion (NMP) is being used increasingly in the United States.  We examined utilization of pediatric donor livers preserved with NMP to assess donor and recipient characteristics as well as outcomes.
Methods:  The UNOS STARfile was queried to examine all pediatric donors who had NMP preservation of the liver starting in 2016 - 2022.  A pediatric donor was defined as one who had donated prior to the age of 18 years.  Donor and recipient demographic data were examined, as were outcomes.  A p-value of <0.05 was considered to be significant. 
Results:  Of the 6056 total pediatric donors, 13 pediatric livers (0.21%) were preserved with NMP over this time period.  When compared to control, NMP donors were significantly older (14.15 vs. 9.22 y, p<0.05), had a higher body mass index (BMI) (27.44 vs. 20.64 kg/m2, p <0.05), longer cold ischemia time (10.75 vs. 6.49 h, p<0.05), and greater donation after cardiac death (DCD) status (61.54% vs. 17.66%, p<0.05).  There were no differences in donor gender, ethnicity, cause of death, biopsy findings, transaminases, donor risk index, or distance to donor center.  Recipients of the pediatric NMP livers were significantly older (59.08 vs. 28.12 y, p<0.05; age range in NMP recipients 42 to 73 y), had a greater BMI (28.41 vs. 22.59 kg/m2, p<0.05), but there were no differences in wait time or MELD score at the time of transplant (21 vs. 16, NMP vs. control).  Length of stay was similar in the NMP vs. control groups (11.88 vs. 22.25 d, p=NS).  None of the NMP livers were lost from cholangiopathy, hepatic artery thrombosis, or primary nonfunction (PNF).  There were also no rejection episodes at 6 and 12 months post transplant in the NMP group.
Conclusion:  Pediatric livers preserved with NMP are from older pediatric donors with higher BMIs and greater DCD status, and none to date have been transplanted into any pediatric recipients.  Pediatric livers preserved with NMP have had good outcomes in adult recipients and should be considered for transplantation into the pediatric population.