HOPE treatment prior to organ transplant alters key immune modulators in patients receiving liver transplantation

Background: Hypothermic oxygenated machine perfusion (HOPE) is recognized as a powerful strategy to protect allografts from ischemia-reperfusion injury. While its benefits on early graft function have been demonstrated in several trials, its specific impact on immune regulation post-transplant remains unexplored. This study aimed to investigate how HOPE influences key immune modulators in patients undergoing liver transplantation.

Methods: A single-center study of 100 patients receiving liver transplantation at the University Hospital RWTH Aachen between 2019 and 2024 was conducted. Of these, 38 received HOPE-treated donor livers, while 62 received livers with standard preservation treatment. Soluble immune markers, including T-cell immunoglobulin mucin domain-containing protein 3 (sTIM-3), sCD163 and programmed death ligand 1 (sPD-L1), were measured in patients` serum before surgery (baseline), within 24 hours post-surgery (POD1) and one week after surgery (POD7).

Results: Patients who received HOPE-treated livers experienced significantly fewer postoperative complications (p=0.04). Post-surgery, these patients exhibited significantly lower sTIM-3 concentrations, a marker involved in T-cell activation, suggesting reduced immune activation. The macrophage activation marker sCD163 was also significantly reduced in the HOPE group. Conversely, sPD-L1, known to inhibit T-cell activation and to promote immune tolerance, was elevated in the HOPE-treated patients, potentially contributing to improved graft tolerance.

Conclusion: Our findings demonstrate that HOPE treatment has an immediate impact on the host immune response in patients following liver transplantation. The observed changes in sTIM-3, sCD163, and sPD-L1 provide early insights in immunemodulatory effects of HOPE and its potential to improve post-transplant outcomes by influencing key immune pathways.

Publication History

Article published online:
20 January 2025