The Role of Ex Situ Hypothermic Oxygenated Machine Perfusion and Cold Preservation Time in Extended Criteria Donation After Circulatory Death and Donation After Brain Death

Abstract

Hypothermic oxygenated machine perfusion (HOPE) has the potential to counterbalance the detrimental consequences of cold and warm ischemia time (WIT) in both donation after brain death (DBD) and donation after circulatory death (DCD). Herein we investigated the protective effects of HOPE in extended criteria donor (ECD) DBD and overextended WIT DCD grafts.The present retrospective case series included 50 livers subjected to end-ischemic HOPE or dual DHOPE in 2 liver transplantation (LT) centers from January 2018 to December 2019. All DCD donors were subjected to normothermic regional perfusion before organ procurement. Results are expressed as median (interquartile range [IQR]). In the study period, 21 grafts were derived from overextended WIT DCD donors (total WIT 54 [IQR, 40-60] minutes and 75% classified as futile), whereas 29 were from ECD DBD. A total of 3 biliary complications and 1 case of ischemia-type biliary lesion were diagnosed. The rate of early allograft dysfunction (EAD) was 20%, and those patients had higher Comprehensive Complication Index scores. Through a changing point analysis, cold preservation time >9 hours was associated with prolonged hospital stays (P = 0.02), higher rates of EAD (P = 0.009), and worst post-LT complications (P = 0.02). Logistic regression analyses indicated a significant relationship between cold preservation time and EAD. No differences were shown in terms of the early post-LT results between LTs performed with DCD and DBD. Overall, our data are fully comparable with benchmark criteria in LT. In conclusion, the application of DHOPE obtained satisfactory and promising results using ECD-DBD and overextended DCD grafts. Our findings indicate the need to reduce cold preservation time also in the setting of DHOPE, particularly for grafts showing poor quality.

Outcome of liver transplantation with grafts from brain-dead donors treated with dual hypothermic oxygenated machine perfusion, with particular reference to elderly donors

“…Previous retrospective studies in the setting of DBD LT 9,11 have suggested that D-HOPE reduces ischemia-reperfusion injury and translates into better postoperative outcomes. In our previous study, 12 D-HOPE use was associated with a reduced rate of postreperfusion syndrome, grade 2-3 AKI and early allograft dysfunction.…”

“…This study shows that end‐ischemic D‐HOPE of livers from DBD donors is associated with a significant reduction of postoperative complications and EAF, leading to improved patient and graft survival. Previous retrospective studies in the setting of DBD LT 9,11 have suggested that D‐HOPE reduces ischemia‐reperfusion injury and translates into better postoperative outcomes. In our previous study, 12 D‐HOPE use was associated with a reduced rate of postreperfusion syndrome, grade 2–3 AKI and early allograft dysfunction.…”

Prolonged preservation by hypothermic machine perfusion facilitates logistics in liver transplantation: A European observational cohort study

“…For example, when the donor liver is reallocated to another recipient in the last minute, or in the event of a difficult recipient hepatectomy. [7][8][9] Good outcomes after prolonged normothermic machine perfusion (NMP) up to 20 h have been reported previously, 10 but the use of prolonged HOPE is still unexplored. In a preclinical study of porcine and discarded human livers, HOPE could succesfully be prolonged for up to 24 h, followed by normothermic reperfusion.…”

“…Whereas a brief period (usually 1–2 h) of HOPE after SCS improves post‐transplant outcomes, machine perfusion time may occasionally be prolonged because of unforeseen transplant logistics. For example, when the donor liver is reallocated to another recipient in the last minute, or in the event of a difficult recipient hepatectomy 7‐9 . Good outcomes after prolonged normothermic machine perfusion (NMP) up to 20 h have been reported previously, 10 but the use of prolonged HOPE is still unexplored.…”

Effluent Molecular Analysis Guides Liver Graft Allocation to Clinical Hypothermic Oxygenated Machine Perfusion

“…Eighteen (47%) grafts were subjected to MP, where 10 were procured from DCD and 8 from DBD-ECD donors meeting the criteria specified above, except for livers 18 and 19, which were subjected to MP to extend the preservation time because of logistic reasons (change of recipient) [36,45,52].…”