The following is a summary of “Routine End-ischemic Hypothermic Oxygenated Machine Perfusion in Liver Transplantation From Donors After Brain Death,” published in the November 2023 issue of Surgery by Grąt, et al.
For a study, researchers sought to find out if end-ischemic hypothermic oxygenated machine perfusion (HOPE) is better than static cold storage (SCS) at keeping livers from donors that have died of brain death (DBD) fresh. There was more and more proof that HOPE can help with liver transplants, but mostly when the patients are at high risk. These were the steps used in the study: livers from DBDs were randomly given to end-ischemic dual HOPE for at least 2 hours or SCS (1:3 allocation ratio). The Model for Early Allograft Function (MEAF) was the main way to measure success. The second measure of success was mortality at 90 days.
Out of the 104 liver transplants in the study, 26 were given to HOPE, and 78 were given to SCS. The mean MEAF for the HOPE group was 4.94, and for the SCS group, it was 5.49 (P=0.24). The rates of MEAF >8 were 3.8% (1/26) for the HOPE group and 15.4% (12/78; P=0.18) for the SCS group. The median number of complications after transplants with HOPE was 20.9, and it was 21.8 after transplants with SCS (P=0.19). Both groups had the same transaminase activity, bilirubin levels, and international normalized ratio.
If the donor risk score was more than 1.70, HOPE was linked to a lower mean MEAF (4.92 vs 6.31; P=0.037) and a lower median Comprehensive Complication score (4.35 vs 22.6; P=0.050). For smaller donor risk index levels, no important changes were seen between HOPE and SCS. It only makes sense to use HOPE sometimes in DBD liver transplants since the clinical effects are only seen in high-risk patients.
