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Prolonged Dual Hypothermic Oxygenated Machine Perfusion for Daytime Liver Transplant
Silke B Bodewes1,2, Linda C Woltjes1,2, Adam M Thorne1,2
1Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
JAMA Network Open
|April 2, 2026
Summary
Prolonged dual hypothermic oxygenated machine perfusion (DHOPE-PRO) significantly increased daytime liver transplants, improving surgical logistics without compromising patient or graft survival. This technique supports broader clinical application in liver transplantation.
Area of Science:
- Organ transplantation
- Machine perfusion technology
- Surgical logistics
Background:
- Liver transplants are time-sensitive procedures often performed at inconvenient hours, causing patient and clinician disutility.
- Short-duration dual hypothermic oxygenated machine perfusion (short-DHOPE) helps mitigate ischemia-reperfusion injury.
- Prolonged DHOPE (DHOPE-PRO) offers potential for extended preservation and facilitation of daytime liver transplants.
Purpose of the Study:
- To evaluate if DHOPE-PRO increases the proportion of daytime liver transplants.
- To assess the impact of DHOPE-PRO on graft and patient outcomes.
- To compare outcomes between DHOPE-PRO and standard perfusion methods.
Main Methods:
- Prospective cohort study comparing liver transplants before (2021-2022) and after (2023-2024) DHOPE-PRO implementation.
- Included adult and pediatric recipients of donation after brain death (DBD), donation after circulatory death (DCD), and living donor grafts.
- Primary outcome: proportion of daytime transplants; Secondary outcomes: 1-year patient/graft survival, complications.
Main Results:
- Daytime transplants increased from 48.4% to 84.6% (reperfusion) and 53.5% to 89.1% (completion) post-DHOPE-PRO implementation (P<.001).
- Median DHOPE duration increased from 2.1 to 10.2 hours, allowing preservation up to 31.4 hours.
- DHOPE-PRO was not associated with increased postoperative complications or compromised 1-year patient/graft survival.
Conclusions:
- Routine DHOPE-PRO implementation significantly increases daytime liver transplants and improves surgical logistics.
- The technique demonstrates comparable safety and efficacy to short-DHOPE, with no adverse impact on graft or patient survival.
- DHOPE-PRO is a valuable tool supporting broader clinical application in liver transplantation.
