Hypothermic oxygenated machine perfusion improves long-term liver transplant outcomes

Hypothermic oxygenated machine perfusion (HOPE) in liver transplantation, when compared to static cold storage (SCS), demonstrates significant advantages in reducing late-onset morbidity and improving long-term graft survival, according to a study.

While previous research established its early advantages, this new study aimed to compare the long-term outcomes of liver transplant recipients using extended criteria donor allografts from donation after brain death (ECD-DBD) randomized to either HOPE or SCS.

The study enrolled 46 patients, with 23 in each arm. The median follow-up period was 48 months.

The analysis focused on late-onset complications occurring beyond 6 months post-transplant, utilizing the Clavien-Dindo Classification and the Comprehensive Complication Index. The results revealed a significant reduction in late-onset morbidity in the HOPE group, with a median reduction of 23 Comprehensive Complication Index points (P = 0.003) and a lower incidence of major complications (Clavien-Dindo ≥3) compared to the SCS group (43% vs 85%, P = 0.009).

However, the study also noted a higher incidence of primary graft loss in the SCS group (n = 10) compared to the HOPE group (n = 3), resulting in a significantly lower overall graft survival in the SCS group (P = 0.029). While adverse 1-, 3-, and 5-year survival probabilities were observed in the SCS group, they did not reach the level of significance compared to the HOPE group (HOPE: 0.913, 0.869, 0.869 vs SCS: 0.783, 0.606, 0.519, respectively).

Reference
Czigany Z, Uluk D, Pavicevic S, et al. Improved outcomes after hypothermic oxygenated machine perfusion in liver transplantation-Long-term follow-up of a multicenter randomized controlled trial. Hepatol Commun. 2024;8(2):e0376. doi: 10.1097/HC9.0000000000000376. PMID: 38315126; PMCID: PMC10843418.

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