Dual Hypothermic Oxygenated Machine Perfusion in Liver Transplants Donated After Circulatory Death

Overview

Journal Br J Surg

Specialty General Surgery

Date 2017 Apr 11

PMID 28394402

Citations 100

Authors

R van Rijn

N Karimian

A P M Matton

L C Burlage

A C Westerkamp

A P van den Berg

R H J de Kleine

M T de Boer

T Lisman

R J Porte

Affiliations

Soon will be listed here.

Abstract

Background: Experimental studies have suggested that end-ischaemic dual hypothermic oxygenated machine perfusion (DHOPE) may restore hepatocellular energy status and reduce reperfusion injury in donation after circulatory death (DCD) liver grafts. The aim of this prospective case-control study was to assess the safety and feasibility of DHOPE in DCD liver transplantation.

Methods: In consecutive DCD liver transplantations, liver grafts were treated with end-ischaemic DHOPE. Outcome was compared with that in a control group of DCD liver transplantations without DHOPE, matched for donor age, donor warm ischaemia time, and recipient Model for End-stage Liver Disease (MELD) score. All patients were followed for 1 year.

Results: Ten transplantations involving liver grafts treated with DHOPE were compared with 20 control procedures. There were no technical problems. All 6-month and 1-year graft and patient survival rates were 100 per cent in the DHOPE group. Six-month graft survival and 1-year graft and patient survival rates in the control group were 80, 67 and 85 per cent respectively. During DHOPE, median (i.q.r.) hepatic adenosine 5'-triphosphate (ATP) content increased 11-fold, from 6 (3-10) to 66 (42-87) µmol per g protein (P = 0·005). All DHOPE-preserved livers showed excellent early function. At 1 week after transplantation peak serum alanine aminotransferase (ALT) and bilirubin levels were twofold lower in the DHOPE group than in the control group (ALT: median 966 versus 1858 units/l respectively, P = 0·006; bilirubin: median 1·0 (i.q.r. 0·7-1·4) versus 2·6 (0·9-5·1) mg/dl, P = 0·044). None of the ten DHOPE-preserved livers required retransplantation for non-anastomotic biliary stricture, compared with five of 20 in the control group (P = 0·140).

Conclusion: This clinical study of end-ischaemic DHOPE in DCD liver transplantation suggests that the technique restores hepatic ATP, reduces reperfusion injury, and is safe and feasible. RCTs with larger numbers of patients are warranted to assess the efficacy in reducing post-transplant biliary complications.

Citing Articles

'Back-to-base' combined hypothermic and normothermic machine perfusion of human donor livers.

van Leeuwen O, Lantinga V, Lascaris B, Thorne A, Bodewes S, Nijsten M Nat Protoc. 2025; .

PMID: 40011689 DOI: 10.1038/s41596-024-01130-8.

Mono-HOPE Versus Dual-HOPE in Liver Transplantation: A Propensity Score-Matched Evaluation of Early Graft Outcome.

Koch D, Tamai M, Schirren M, Drefs M, Jacobi S, Lange C Transpl Int. 2025; 38:13891.

PMID: 39974599 PMC: 11835512. DOI: 10.3389/ti.2025.13891.

Real-Time Biomarkers of Liver Graft Quality in Hypothermic Oxygenated Machine Perfusion.

Zhylko A, Morawski M, Rykowski P, Krasnodebski M, Wyporski A, Borkowski J J Clin Med. 2025; 14(2).

PMID: 39860477 PMC: 11766178. DOI: 10.3390/jcm14020471.

Cost-effectiveness of Dual Hypothermic Oxygenated Machine Perfusion Versus Static Cold Storage in DCD Liver Transplantation.

Endo C, van Rijn R, Huurman V, Schurink I, van den Berg A, Murad S Transplantation. 2025; 109(2):e101-e108.

PMID: 39853733 PMC: 11745596. DOI: 10.1097/TP.0000000000005232.

Challenges and opportunities in organ donation after circulatory death.

Mathias V, Vidgren M, Delorme C, Capucine D, Oniscu G J Intern Med. 2025; 297(2):124-140.

PMID: 39829342 PMC: 11771584. DOI: 10.1111/joim.20051.

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