Early experience of routine end-ischemic hypothermic oxygenated machine perfusion (HOPE) In liver transplantation

Background: Hypothermic oxygenated liver perfusion (HOPE) has proven to be a promising approach to reduce ischemia-reperfusion injury (IRI) following liver transplantation (LTx), especially due to the increasing use of extended criteria donor (ECD) organs. In our monocentric study we report the early results after routine use of end-ischemic HOPE in comparison with a historical cohort preserved by static cold storage (SCS).

Methods: Between November 2023 and March 2025 46 consecutive LTx underwent routine HOPE at our institution. Outcomes were compared to a retrospective cohort from May 2010 to September 2020 of 438 livers preserved by SCS alone.

Results: The SCS group has significantly lower labMELD Scores (20.47 (6-40) in SCS vs. 24.28 (7-40) in HOPE, p=0.024) and shorter cold ischemia times (513.3 (20-1062) min in SCS vs. 643.22 (304-915) min in HOPE, p<0.001). Therefore, the rate of ECD graft was significantly higher in the group with routine end-ischemic HOPE (67.0% in SCS vs. 84.8% in HOPE, p=0.017). Despite the higher risk profile in the HOPE group, there is a tendency towards fewer early allograft dysfunction (EAD) according to the definition of Olthoff et al. (29.4% after SCS vs. 26.7% after HOPE, p>0.05). Moreover, patients after transplantation of a previously perfused liver showed significantly decreased levels of and ALT (381.8 U/l vs. 305.9 U/l, p=0.022) and AST (p>0.05) in the first postoperative days. No adverse events related to the use of HOPE were observed.

Conclusion: The early results of our institution demonstrate that the routine use of end-ischemic HOPE in LTx is feasible, safe and associated with a tendence to an improved short-term outcome even in a cohort of more critically ill patients. These results justify the broader implementation of HOPE as a standard in liver graft preservation.

Publikationsverlauf

Artikel online veröffentlicht:
04. September 2025