Hypothermic oxygenated perfusion: cellular mechanisms and clinical outcomes

Machine perfusion has emerged as a transformative technique in organ transplantation, helping to address the persistent organ shortage while mitigating ischemia-reperfusion injury. Since the 2010s, its implementation in Europe has expanded access to life-saving transplants. This review examines the impact of hypothermic oxygenated perfusion (HOPE) on liver transplantation, with a focus on viability assessment, posttransplant complications, oncologic outcomes, organ utilization, and cost-effectiveness.

HOPE offers significant advantages over traditional cold storage preservation including enhanced mitochondrial protection, reduced oxidative stress, and improved posttransplant recovery. Studies have demonstrated its effectiveness in lowering the incidence of graft dysfunction, biliary complications, and overall transplant-related issues. Additionally, HOPE provides viability assessment by incorporating biomarkers such as flavin mononucleotide (FMN) and syndecan-1 (Sdc-1), which may aid in graft selection and predicting posttransplant outcomes. This review explores the cellular mechanisms underlying HOPE, its influence on graft function and transplant success, and its role in enhancing viability assessment and cost-effectiveness.

HOPE represents a significant advancement in liver transplantation, offering a safer, more efficient alternative to traditional preservation methods. By improving both clinical outcomes and being cost efficient, this technique has the potential to become a standard of care in liver transplantation. Further research should focus on refining viability assessment protocols, optimizing logistical implementation, and expanding clinical adoption to maximize organ utilization and improve patient survival.