Routine end-ischemic hypothermic machine perfusion in liver transplantation from donors after brain death: results of 2-year follow-up of a randomized controlled trial.

Background: Data on routine hypothermic machine perfusion of livers procured from donors after brain death (DBD) are scarce, and the benefits of the method have only been demonstrated in extended criteria grafts. This study aimed to assess if end-ischemic dual hypothermic oxygenated machine perfusion (dHOPE) is superior to static cold storage (SCS) in preservation of livers procured from DBD donors with respect to long-term outcomes. Existing data on short-term outcomes favours dHOPE in patients receiving high-risk grafts.

Methods: This prospective randomized controlled trial included 104 recipients of DBD livers randomly assigned to SCS arm (78 patients) and the dHOPE arm (26 patients). Endpoints of interest were the occurrence of biliary complications (biliary fistula, anastomotic, and nonanastomotic strictures) and overall patient and graft survival (GS) during the 2-year follow-up.

Results: A total of 36 patients developed biliary complications (at least one event) - six events in dHOPE arm and 30 in SCS arm. There was no significant difference in biliary complications between groups (23.7 vs. 43.4%, P =0.11). No differences were found significant with respect to anastomotic (19.9 vs. 33.7%, P =0.20) and nonanastomotic strictures (0 vs. 11.1%, P =0.10) as well as biliary fistulas (11.7 vs. 12.2%, P =0.93). Survival analysis did not show significantly different results in the study population - overall survival: 92.3% in dHOPE and 83.9% in SCS ( P =0.35), and GS: 92.3 and 81.4% ( P =0.23), respectively. However, a significant difference in GS was noted in recipients of high-risk grafts - 100% in dHOPE and 73.1% in SCS, respectively ( P =0.038).

Conclusions: The long-term outcome data suggest that the routine use of dHOPE may be beneficial for recipients of high-risk grafts from DBD donors. The present study does not provide any evidence for the benefits of dHOPE in low-risk grafts.