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.
