reduced RFS included non-insulinoma histology, known genetic syndrome, LN(+) disease, R1 margin, and lack of SI. On MV analysis, only the failure to achieve SI following resection persisted as being associated with reduced RFS(Table). Considering only pts with an R0 resection, failure to achieve SI was still associated with worse 3-yr RFS compared to pts with SI(36%vs80%;p=0.006). Conclusions: Failure to achieve symptomatic improve- ment after resection of functional NETs is associated with worse recurrence-free survival, even when accounting for histologic type, presence of genetic syndromes, R1 resec- tion, and LN involvement. These patients may benefit from short-interval periodic imaging postoperatively to assess for earlier radiographic recurrence of disease. FP05 - Free Papers 5 (long oral) - Transplant 1 FP05-01 FACTORS PREDICTING VIABILITY ACHIEVEMENT ON DISCARDED DONOR LIVERS SUBMITTED TO EXTRA-CORPOREAL MACHINE PERFUSION Y. Longatto Boteon 1,2 , R. Laing 1,2 , A. Schlegel 1 , J. Attard 1,2 , L. Wallace 2 , R. Bhogal 1 , D. Neil 1 , D. Mirza 1 , H. Mergental 1 and S. Afford 2 1 Liver Unit, Queen Elizabeth Hospital Birmingham, and 2 National Institute for Health Research, Birmingham Liver Biomedical Research Centre, University of Birmingham, United Kingdom Introduction: Ex-vivo machine perfusion of livers (MP) may offer superior preservation for marginal donor organs. During normothermic machine perfusion (NMP) is possible to assess liver viability before transplantation. A period of hypothermic machine perfusion (HMP) prior to NMP may restore the liver metabolism. The aim of this study was to compare viability criteria achievement in livers subjected to NMP-only or a combination of HMP followed by NMP; and, analyse factors associated with the positive outcome. Methods: We analysed 46 discarded human livers sub- mitted to MP including NMP alone for 6 hours or a com- bined protocol of HMP for 2 hours followed by NMP for further 4 hours. Viability was assessed at the end of the NMP in both groups using the lactate clearance criteria. Results: Steatosis was the main for organ discard (46%). 24/46 (52%) organs achieved viability criteria. From 29 livers that had NMP-only 12 (41%) met viability compared to 12 (71%) from the 17 livers submitted to the combined protocol (p=0.050). Non-viable livers had higher donor BMI (p=0.048) and liver weight (p=0.011) and were discarded more often for steatosis (p=0.001). On multi- variable analysis livers declined for steatosis (OR:50.6; 95%CI:3.7-688.9; p=0.003), donor height (OR:1.1; 95% CI:1.1-1.2; p=0.039) and NMP alone (OR:10.3; 95% CI:1.5-70.9; p=0.018) were independent risk factors for non-achievement of the viability criteria. Conclusion: Combination of HMP and NMP can increase the rescue of very-high risk extended criteria donor livers. However steatosis remains the major risk factor for non- viability achievement. New strategies to improve those organs still needed. FP05-02 EX VIVO SUBNORMOTHERMIC REGULATED HEPATIC REPERFUSION IS SUPERIOR TO NORMOTHERMIC MACHINE PERFUSION: A NOVEL CONCEPT OF LIVER RESUSCITATION AFTER CARDIAC DEATH IN LARGE ANIMAL MODEL J. Kim 1 , W. Y. Shin 1 , M. A. Zimmerman 1 , A. Martin 1 , J. Yee 1 , C. Hagen 2 , J. McGraw 3 , A. Camara 4 , D. Stowe 4 and J. C. Hong 1 1 Transplant Surgery, Medical College of Wisconsin, 2 Pa- thology, Medical College of Wisconsin, 3 Concordia Uni- versity, and 4 Anesthesiology, Medical College of Wisconsin, United States Introduction: Livers procured after cardiac death suffer extreme degree of ischemia - reperfusion injury (IRI) and at increased risk of graft failure after liver transplantation (LT). Regulated hepatic reperfusion (RHR) is a novel organ resus- citation therapy that facilitates hepatic mitochondrial and microcirculatory recovery from IRI using an energy substrate- enriched, leukocyte-depleted, oxygen-saturated perfusate delivered in a pressure, and temperature -controlled milieu. Methods: Using a swine donation after cardiac (DCD) model, all livers were subjected to 1 hour of in situ warm ischemia and 2 hours of cold static (CS) preservation. All livers were subsequently reperfused and monitored for 2 hours in the ex vivo perfusion machine. Four methods of reperfusion were compared. 5 animals in each treatment group. Group I: Sanguineous-Subnormothermic (SS); Group II: RHR-Subnormothermic (RHR-S); Group III: Sanguineous-Normothermic (SN); Group IV: RHR- FP04-05 Table 1 Variable Univariable Multivariable Hazard Ratio 95% CI p-value Hazard Ratio 95% CI p-value Type of Functional Tumor Insulinoma Ref – – Ref – – Gastrinoma 2.8 (1.3-6.1) 0.006 1.1 (0.6-2.0) 0.75 Other (glucagonoma, somatostatinoma, VIPoma) 2.7 (1.0-7.2) 0.042 – – – Known Genetic Syndrome 1.8 (0.9-3.5) 0.077 0.68 (0.2-2.0) 0.49 Lymph Node Positive 1.8 (0.9-3.6) 0.080 1.6 (0.6-4.6) 0.35 R1 Resection Margin 2 (1.0-3.9) 0.052 0.45 (0.1-1.8) 0.25 Failure of Symptom Improvement 3.1 (1.3-7.2) 0.008 4.7 (1.3-16.6) 0.016 HPB 2018, 20 (S2), S182eS294 S196 Free Orals (FP01-FP31)