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Updated: Sep 7, 2025
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Reducing cold ischemia time by donor liver "back-table" preparation under continuous oxygenated machine perfusion of
Veerle A Lantinga1, Carlijn I Buis1, Robert J Porte1
1Department of Surgery, section of Hepatobiliary Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Introduction:
Cold ischemia time is a well-known risk factor for the development of non-anastomotic biliary strictures (NAS) after liver transplantation. End-ischemic hypothermic oxygenated machine perfusion (HOPE) of DCD liver grafts reduces the incidence of NAS, and has the potential to reduce cold ischemia times. We hypothesized that if a part of the back-table procedure could be performed under continuous HOPE, cold ischemia times would be reduced.
Methods:
In this prospective observational cohort study, all nationwide declined livers that underwent DHOPE-NMP between July 1st 2021 and January 1st 2022 were included. The back-table of ten consecutive high-risk donor livers was performed with ongoing HOPE. Sixty DHOPE-NMP procedures (August 1st 2017-July 1st 2021) with a conventional back-table procedure functioned as a control group.
Results:
Compared to the control group, this technique led to a decrease in non-oxygenated back-table time from median 74 min (IQR 58-92 min) to median 25 min (IQR 21-31 min), p < .01. Median total cold preservation times were reduced from 279 min (IQR 254-297) to 214 min (IQR 132-254), p < .01.
Conclusion:
Cold ischemia time of liver grafts can be successfully reduced by over one hour by using portal vein only HOPE during back-table preparation.
