• Michał Grąt, Marcin Morawski, Andriy Zhylko, Paweł Rykowski, Maciej Krasnodębski, Anya Wyporski, Jan Borkowski, Zbigniew Lewandowski, Konrad Kobryń, Rafał Stankiewicz, Jan Stypułkowski, Wacław Hołówko, Waldemar Patkowski, Magdalena Mielczarek-Puta, Marta Struga, Benedykt Szczepankiewicz, Barbara Górnicka, and Marek Krawczyk.
• Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
• Ann. Surg. 2023 Nov 1; 278 (5): 662668662-668.

ObjectiveTo assess whether end-ischemic hypothermic oxygenated machine perfusion (HOPE) is superior to static cold storage (SCS) in preserving livers procured from donors after brain death (DBD).BackgroundThere is increasing evidence of the benefits of HOPE in liver transplantation, but predominantly in the setting of high-risk donors.MethodsIn this randomized clinical trial, livers procured from DBDs were randomly assigned to either end-ischemic dual HOPE for at least 2 hours or SCS (1:3 allocation ratio). The Model for Early Allograft Function (MEAF) was the primary outcome measure. The secondary outcome measure was 90-day morbidity (ClinicalTrials. gov, NCT04812054).ResultsOf the 104 liver transplantations included in the study, 26 were assigned to HOPE and 78 to SCS. Mean MEAF was 4.94 and 5.49 in the HOPE and SCS groups ( P =0.24), respectively, with the corresponding rates of MEAF >8 of 3.8% (1/26) and 15.4% (12/78; P =0.18). Median Comprehensive Complication Index was 20.9 after transplantations with HOPE and 21.8 after transplantations with SCS ( P =0.19). Transaminase activity, bilirubin concentration, and international normalized ratio were similar in both groups. In the case of donor risk index >1.70, HOPE was associated with significantly lower mean MEAF (4.92 vs 6.31; P =0.037) and lower median Comprehensive Complication Index (4.35 vs 22.6; P =0.050). No significant differences between HOPE and SCS were observed for lower donor risk index values.ConclusionRoutine use of HOPE in DBD liver transplantations does not seem justified as the clinical benefits are limited to high-risk donors.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

15 keywords...

hide…