Utilization of Paragonix LIVERguard® donor organ transport system for static hypothermic preservation of a multivisceral allograft

Background Intestine transplants are highly sensitive to ischemia-reperfusion injury (IRI). Static cold storage (SCS) is the standard for multivisceral (MVT) allograft preservation but carries known risks. While several devices have been developed for liver, lung, and heart graft preservation, there are no systems validated specifically for MVT grafts. We report the first use of the Paragonix LIVERguard® Donor Liver Transport System for hypothermic static preservation of a donation after brain death (DBD) MVT allograft, transported approximately 1363 miles. Methods The Paragonix LIVERguard® was used to preserve a pediatric MVT graft during long-distance transport between the donor and recipient hospitals. We collected donor and recipient characteristics, ischemia intervals, lab markers of IRI, vasopressor duration, intensive care unit (ICU) and hospital length of stay, and time to enteral feeding. Results The graft included liver, stomach, pancreas, spleen, small intestine, and colon. Cold ischemia time (CIT) was 6.8 h. The device maintained a mean temperature of 4.5°C (range: 3.8–5.2°C). Endoscopy showed no evidence of rejection. There was rapid normalization of both enzymatic injury markers (AST/ALT) and metabolic markers (lactate). Enteral feeding began on POD 13 and advanced to the goal. She was discharged home on POD 103. Conclusion This case represents the first reported use of the Paragonix LIVERguard® for MVT graft preservation and transport. The device maintained a narrow temperature range over a 6.8-hour CIT and more than 1300 miles of travel. Relative to historical institutional experience, the case demonstrated lower peak biochemical markers and faster normalization of graft function. These findings support further investigation into whether preservation strategies that maintain tighter thermal control may influence early graft recovery in MVT.