Related Experiment Video
Updated: Nov 16, 2025
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Hypothermic Machine Perfusion in Liver Transplantation - A Randomized Trial
Rianne van Rijn1, Ivo J Schurink1, Yvonne de Vries1
1From the Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation (R.R., Y.V., O.B.L., V.E.M., R.J.P.), the Departments of Gastroenterology and Hepatology (A.P.B.) and Radiology (R.J.H., J.J.G.S.), University of Groningen, University Medical Center Groningen, Groningen, the Departments of Surgery (I.J.S., W.G.P., J.J.) and Gastroenterology and Hepatology (S.D.M.), Erasmus University Medical Center, Rotterdam, and the Departments of Surgery (J.I.E., V.A.L.H.) and Gastroenterology and Hepatology (B.H.), Leiden University Medical Center, Leiden - all in the Netherlands; the Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London (M.C.C., N.H.); the Transplantation Research Group, the Department of Microbiology, Immunology, and Transplantation, Katholieke Universiteit Leuven, and the Department of Abdominal Transplantation Surgery and Coordination, University Hospitals Leuven, Leuven (N.G., I.J., D.M.), and the Department of Transplant Surgery, Ghent University Hospital, Ghent (R.I.T., A.V.) - both in Belgium.
Hypothermic oxygenated machine perfusion significantly reduced biliary strictures in liver transplants from circulatory death donors. This innovative technique offers a safer alternative to traditional cold storage, improving patient outcomes.
Area of Science:
- Transplantation Medicine
- Organ Preservation
- Surgical Innovation
Background:
- Liver transplantation from donors after circulatory death (DCD) carries a higher risk of nonanastomotic biliary strictures.
- Hypothermic oxygenated machine perfusion (HOPE) is a novel technique explored to mitigate these complications.
- Limited prospective data exists on HOPE's efficacy in DCD liver transplantation.
Purpose of the Study:
- To evaluate the effectiveness of HOPE in reducing nonanastomotic biliary strictures after DCD liver transplantation.
- To compare HOPE with conventional static cold storage in a controlled trial setting.
- To assess secondary outcomes including graft-related and general complications.
Main Methods:
- A multicenter, controlled trial randomly assigned DCD liver transplant recipients to either HOPE or static cold storage.
- The primary endpoint was the incidence of nonanastomotic biliary strictures within six months post-transplant.
- Secondary endpoints included postreperfusion syndrome, early allograft dysfunction, and adverse events.
Main Results:
- Nonanastomotic biliary strictures occurred in 6% of the HOPE group versus 18% in the control group (risk ratio, 0.36).
- HOPE significantly reduced postreperfusion syndrome (12% vs. 27%) and early allograft dysfunction (26% vs. 40%).
- Treatments for biliary strictures were nearly four times lower in the HOPE group, with similar adverse event rates.
Conclusions:
- Hypothermic oxygenated machine perfusion is superior to static cold storage in lowering the risk of nonanastomotic biliary strictures in DCD liver transplantation.
- HOPE demonstrates significant benefits in reducing key complications like postreperfusion syndrome and early allograft dysfunction.
- This study provides strong evidence supporting the adoption of HOPE for DCD liver preservation.
