Preservation of Liver Graft Using the Hypothermic Oxygenated Perfusion (HOPE) System: A single-center experience

The hypothermic oxygenated perfusion (HOPE) system has been developed to improve the quality of previously considered suboptimal liver grafts, reduce complications, and increase the number of available donors. The aim of this study is to evaluate the results since its implementation in the liver transplant (LT) program at our center.

We conducted a retrospective descriptive analysis of all LTs with HOPE from August 2022 to November 2023 with a minimum follow-up of 3 months. The indication criteria included: donor >75 years, macrovesicular steatosis (>30%) confirmed by biopsy, donor >70 years with additional risk factors (macroscopic steatosis or grossly suboptimal liver), anticipated cold ischemia time >6 hours, and donation after circulatory death with suboptimal graft or laboratory results.

Of the 96 LTs performed during this period, HOPE was used in 12 cases (12.5%). Two patients (16.7%) experienced postreperfusion syndrome, and one (8.3%) early allograft dysfunction was noted. Four patients (33.3%) had major surgical complications (Clavien-Dindo ≥ III). The median peak of ALT during the first 48 hours was 438.5 U/L (range 128-2475). There were two biliary complications (16.7%), one venous complication (8.3%), and two arterial complications (16.7%). With a median follow-up of 7.8 months, both patient survival and graft survival were 100%.

In our experience, the use of HOPE seems to reduce ischemic damage and shows good short- and medium-term results.