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Updated: Feb 19, 2026
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Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
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Hypothermic Oxygenated Machine Perfusion for Liver Transplantation: An Initial Experience
Damiano Patrono1, Bruna Lavezzo, Luca Molinaro
1From the Department of General Surgery, Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
Summary
Hypothermic oxygenated machine perfusion for high-risk liver transplants demonstrated safety and logistical simplicity. While early allograft dysfunction occurred in 50% of cases, all patients showed normal liver function at six months with no biliary complications.
Area of Science:
- Transplantation research
- Organ preservation techniques
- Machine perfusion technologies
Background:
- Extended criteria donors are increasingly utilized for liver transplantation.
- Machine perfusion, particularly hypothermic oxygenated machine perfusion (HOPE), is an emerging alternative to static cold storage.
- HOPE has shown promise in improving liver transplant outcomes in preclinical and clinical studies.
Purpose of the Study:
- To evaluate the initial clinical experience with end-ischemic dual hypothermic oxygenated machine perfusion for high-risk liver transplants.
- To assess the incidence of postreperfusion syndrome (PRS) and early allograft dysfunction (EAD).
- To determine the rate of long-term biliary complications.
Main Methods:
- Four high-risk liver transplant recipients underwent end-ischemic dual (hepatic artery and portal vein) hypothermic oxygenated machine perfusion for 150-200 minutes.
- Organs were considered high-risk due to donor, recipient, or matching factors.
Main Results:
- No device malfunctions were reported, and theatre logistics were minimally impacted.
- The incidence of postreperfusion syndrome was 25%, and early allograft dysfunction was 50%.
- At six-month follow-up, all patients were alive with normal hepatic function and no evidence of ischemic cholangiopathy.
Conclusions:
- Hypothermic oxygenated machine perfusion appears safe and logistically straightforward in this initial series.
- Further research is necessary to establish the definitive clinical value of HOPE.
- Identifying specific patient subsets who would most benefit from HOPE is a key future direction.
