Dual hypothermic oxygenated machine perfusion (DHOPE) improves extended allocation graft function in liver transplantation

Background

Patients with end-stage liver disease or liver tumours can only be treated curatively with liver transplantation (LTx). The glaring organ shortage and the increasing allocation of marginal donor organs is an international challenge. These organs can be accepted and transplanted with good results through preconditioning using machine perfusion (MP). This makes it possible to shorten the waiting list time and thus reduce the dropout rate from the waiting list, especially for patients with hepatocellular carcinoma.

Materials and Methods

The Magdeburg Liver Surgery Register/ Study was screened for the last 132 liver transplant patients. Of these, 18 were transplanted with Dual Hypothermic Oxygenated Machine (DHOPE) perfusion and 114 without (non-MP). Recipient demographic, perioperative and follow-up data were retrospectively collected and analysed. Donor data and risk factors were evaluated.

Results

The mean recipient age with DHOPE was 57.4 years vs. non-MP 55.9 years. The mean donor age was higher in the DHOPE Group (64.5 vs. 58.3 years, p = 0.073). The mean DHOPE time was 371.0 (57–945) minutes. The DHOPE reduced the cold ischemic time significant (7.1 vs. 8.4 h, p = 0.010). The Donor Risk Index was higher with DHOPE (1.903 vs. 1.889, p = 0.869). The rate of Re-LTx was 0 % vs 7.0 % with and without DHOPE (p = 0.299). The rate of EAD and primary non-function DHOPE vs. non-MP was 23.5 % vs. 27.8 % (p = 0.485) and 0.0 % vs. 5.3 % (p = 0.427). DHOPE significantly increased the rate of extended or rescue allocation from 26.3 % to 61.1 % (p = 0.003). With DHOPE, the donor age was higher (64.5 vs. 58.3 years, p = 0.0.073). The postoperative ICU time was significantly shorter after DHOPE (7.2 vs. 13.6 days, p = 0.044). The hospitalisation time after LTx was not significant, but it tended to be shorter at 28.7 vs 39.3 days (p = 0.097). The 1-year survival rate with and without DHOPE was 88,9 % vs. 80,3 % (p = 0593).

Conclusion

The increasing proportion of marginal donor organs requires optimisation of organ reconditioning, as is possible with Dual Hypothermic Oxygenated Machine Perfusion. Reduction of reperfusion damage leads to better postoperative graft function and thus faster convalescence. As the data show, marginal organs can be transplanted safely and with a good result using DHOPE.