Further optimization and improvement of normothermic machine perfusion (NMP) is necessary, as it can still lead to ischemia injury in transplanted livers. We propose a novel method, termed ischemia‐free liver implantation (IFLI), which maintains a constant blood supply throughout both the preservation and implantation processes. This study aimed to evaluate the feasibility and safety of IFLI compared to NMP.

Thirty‐four recipients of IFLI and 17 recipients of NMP were enrolled. The recovery of liver function, complication rates, and survival outcomes were compared between the groups.

The mean cold ischemia time (CIT), anhepatic time, and surgical duration were 5.94 ± 0.41 h, 50.59 ± 2.10 min, and 439.32 ± 13.25 min for the IFLI group, and 6.29 ± 0.52 h, 54.65 ± 4.32 min, and 428.06 ± 22.04 min for the NMP group (p = 0.333, 0.086, and 0.135, respectively). The IFLI group had a significantly lower incidence of post‐reperfusion syndrome compared to the NMP group (8% vs. 58.8%, p < 0.001), and the incidence rate of PNF was higher in the NMP group (p = 0.041).

IFLI, by maintaining constant blood supply during implantation, avoids re‐ischemia‐reperfusion injury (re‐IRI) and demonstrates improved postoperative liver function recovery, fewer complications, and greater safety compared to standard NMP.