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Updated: Jul 11, 2025
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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
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Screening for mitochondrial function before use-routine liver assessment during hypothermic oxygenated perfusion
Janina Eden1, Eva Breuer1, Dominique Birrer1
1Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
Ebiomedicine
|November 2, 2023
Summary
Hypothermic oxygenated perfusion (HOPE) enables reliable assessment of donor livers, improving transplant decisions and outcomes. This technique allows objective evaluation of liver quality, even for high-risk organs, leading to comparable survival rates to ideal grafts.
Area of Science:
- Organ transplantation
- Ex situ organ perfusion
- Hepatology
Background:
- Assessing liver graft viability is crucial for successful transplantation.
- Donation after circulatory death (DCD) livers present unique challenges for utilization.
- Hypothermic oxygenated perfusion (HOPE) offers a potential solution for ex situ liver assessment.
Purpose of the Study:
- To evaluate the concept of liver assessment during ex situ hypothermic oxygenated perfusion (HOPE).
- To determine the impact of HOPE on liver utilization, particularly for DCD livers.
- To report on the development and implementation of perfusate assessment of mitochondrial biomarkers during HOPE.
Main Methods:
- Analysis of prospectively collected data on DCD livers treated with HOPE over an 11-year period (2012-2022).
- Routine perfusate assessment of mitochondrial biomarkers (flavin mononucleotide, NADH, CO2 production) during HOPE.
- Comparison of graft survival and loss rates with benchmark data for ideal donor livers.
Main Results:
- 158 DCD Maastricht III liver transplants were performed with 1-year patient survival of 87% and death-censored graft survival of 89%.
- Graft loss due to primary non-function or cholangiopathy was low (4.4% and 6.9%, respectively).
- Graft survival was comparable to ideal donor livers, irrespective of UK-DCD risk score, due to objective perfusate assessment.
Conclusions:
- HOPE is a suitable and straightforward perfusion method for reliable liver graft assessment post-cold storage.
- HOPE enables informed decisions regarding liver implantation, especially for high-risk organs like DCD livers or those with steatosis.
- Combining HOPE with viability assessment enhances the utilization of marginal liver grafts.
