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Updated: Oct 16, 2026
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Economic Evaluation of Prolonged Hypothermic Oxygenated Machine Perfusion Enabling Daytime Liver Transplantation
Linda C Woltjes1,2, Marijke I Bonnema3, Isabel M A Brüggenwirth1,2
1Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Background:
Short-duration (1-2 h) dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury-related complications. Prolonged DHOPE preservation (DHOPE-PRO) may facilitate logistics. We assessed the economic impact of DHOPE-PRO versus conventional short-duration DHOPE, hypothesizing that DHOPE-PRO would not be associated with increased one-year transplantation-related costs.
Methods:
This post hoc economic evaluation of the prospective DHOPE-PRO trial (NL8740) included adult recipients of livers donated after brain death. All transplantation-related medical expenses up to one year post-transplant were collected. The cost of resource use was calculated using 2022 full hospital prices indexed to 2024. Time-driven variable costing was applied to perfusion, surgery, and intensive care costs. The primary outcome was total one-year transplantation-related cost.
Results:
Of 24 patients, 12 received a liver after DHOPE and 12 after DHOPE-PRO. Median one-year total costs were €83 583 [interquartile range (IQR) 78 400-104 158] for DHOPE and €78 582 [IQR 73123-92 855] for DHOPE-PRO (p = 0.347). Perfusion costs were higher with DHOPE-PRO (€23 926 [IQR 22711-24 697] versus €17 306 [IQR 16928-17 594]; p < 0.001), while surgery costs were lower (€18 560 [IQR 17806-20 747] versus €21 303 [IQR 19535-25 418]; p = 0.033). Costs related to other medical activities did not differ between groups.
Conclusion:
In this exploratory single-center economic evaluation, DHOPE-PRO enabled daytime liver transplantation without evidence of increased one-year transplantation-related costs compared with short-duration DHOPE. Higher perfusion-related costs were accompanied by lower surgery-related costs in this cohort. These findings warrant confirmation in larger studies.
Trial Registration:
Netherlands Trial Registry number: NL8740.
