Machine Perfusion After Cold Storage Improves Outcomes of Extended-Criteria Liver Grafts

NEW YORK (Reuters Health) – Extended criteria donor livers treated with dual hypothermic oxygenated machine perfusion (D-HOPE) have lower rates of graft failure and are associated with fewer post operative complications in recipients, researchers report.

In a single center study published in the American Journal of Transplantation, Dr. Damiano Patrono and colleagues at University of Turin, Italy reviewed data on 121 livers from extended-criteria brain-dead donors that were treated with D-HOPE (oxygenated perfusion through both the portal vein and hepatic artery) for a minimum of 90 minutes after removal from cold storage. Extended criteria included age >80, age >70 with additional risk factors, or grafts of any age with significant steatosis.

Compared to recipients of 723 livers from extended-criteria donors that were preserved with cold storage alone, recipients of grafts treated with D-Hope had significantly lower rates of early graft failure (2.65% vs 9.6%) and Grade 3 Clavien-Dindo complications (17.4% vs 24.9%) and showed a trend toward a lower risk for acute kidney injury. Ischemic cholangiopathy was found to be less severe in D-Hope recipients.

Of the three cases of early graft failure in the D-HOPE group, two were from donors with 30% and 40% macrosteatosis, suggesting caution when using livers with significant macrovesicular fat.

Among 240 recipients of grafts from elderly donors (>75 years), the 63 recipients of D-HOPE preserved allografts had significantly improved patient and graft survival, lower rates of early allograft failure (0 vs 8.5%), postoperative death (0 vs 5.6%) and need for dialysis (0 vs 2.8%).

A “simple intervention applied at the end of cold preservation improves graft survival and posttransplant course,” the researchers said. In light of the significant benefit of using D-HOPE in elderly donors, they urge “wider adoption of D-Hope in this setting.”

In a separate report in a later issue of the same journal, Dr. Damiano and colleagues note that while a short period (1-2 hours) of HOPE after static cold storage is safe and reduces ischemia-reperfusion injury-related complications after liver transplantation, machine perfusion time is occasionally prolonged for logistical reasons. In multicenter study, they analyzed outcomes in 93 recipients of livers preserved by prolonged (≥4 hours) HOPE, for a total preservation time of nearly 21 hours. Postoperative peak ALT was 675 IU/L, the incidence of postoperative complications was low, and 1-year graft and patient survival were 94%, and 88%, respectively, they reported.

“These results suggest that simple, end-ischemic HOPE may be utilized for safe extension of the preservation time to ease transplantation logistics,” the researchers concluded.

SOURCE: and American Journal of Transplantation, online February 12 and March 21, 2022.

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