Highlights
- •End-ischemic HOPE protected against arterial and biliary complications, resulting in significantly less graft loss.
- •Equivalent outcomes were achieved with HOPE as with primary DBD liver transplants.
- •HOPE after cold storage is a simple and effective method to treat high-risk DCD livers prior to implantation.
Background & Aims
Donation after circulatory death (DCD) liver transplantation is known for potentially
worse outcomes because of higher rates of graft non-function or irreversible cholangiopathy.
The impact of machine liver perfusion techniques on these complications remains elusive.
We aimed to provide data on 5-year outcomes in patients receiving DCD liver transplants,
after donor organs had been treated by hypothermic oxygenated perfusion (HOPE).
Methods
Fifty HOPE-treated DCD liver transplants performed in Zurich between 2012 and 3/2017
were matched with 50 primary donation after brain death (DBD) liver transplants, and
with 50 untreated DCD liver transplants in Birmingham. Match factors focussed on short
cold ischaemia, comparable recipient age and low recipient laboratory model for end-stage
liver disease scores. Primary endpoints were post-transplant complications, and non-tumour-related
patient death or graft loss.
Results
Despite extended donor warm ischaemia, HOPE-treated DCD liver transplants achieved
similar overall graft survival, compared to standard DBD liver transplants. Particularly,
graft loss due to any non-tumour-related causes occurred in 8% (4/50) of cases. In
contrast, untreated DCD livers resulted in non-tumour-related graft failure in one-third
(16/50) of cases (p = 0.005), despite significantly (p <0.001) shorter functional donor warm ischaemia. Five-year graft survival, censored
for tumour death, was 94% for HOPE-treated DCD liver transplants vs. 78% in untreated DCD liver transplants (p = 0.024).
Conclusions
The 5-year outcomes of HOPE-treated DCD liver transplants were similar to those of
DBD primary transplants and superior to those of untreated DCD liver transplants,
despite much higher risk. These results suggest that a simple end-ischaemic perfusion
approach is very effective and may open the field for safe utilisation of extended
DCD liver grafts.
Lay summary
Machine perfusion techniques are currently being introduced into the clinic, with
the aim of optimising injured grafts prior to implantation. While short-term effects
of machine liver perfusion have been frequently reported in terms of hepatocellular
enzyme release and early graft function, the long-term benefit on irreversible graft
loss has been unclear. Herein, we report on 5-year graft survival in donation after
cardiac death livers, treated either by conventional cold storage, or by 1–2 h of
hypothermic oxygenated perfusion (HOPE) after cold storage. Graft loss was significantly
less in HOPE-treated livers, despite longer donor warm ischaemia times. Therefore,
HOPE after cold storage appears to be a simple and effective method to treat high-risk
livers before implantation.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 17, 2018
Accepted:
October 2,
2018
Received in revised form:
September 28,
2018
Received:
June 23,
2018
Identification
Copyright
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
