TY - JOUR
T1 - Hypothermic Oxygenated Machine Perfusion Reduces Early Allograft Injury and Improves Post-transplant Outcomes in Extended Criteria Donation Liver Transplantation From Donation After Brain Death
T2 - Results From a Multicenter Randomized Controlled Trial (HOPE ECD-DBD)
AU - Czigany, Zoltan
AU - Pratschke, Johann
AU - Froněk, Jiří
AU - Guba, Markus
AU - Schöning, Wenzel
AU - Raptis, Dimitri Aristotle
AU - Andrassy, Joachim
AU - Kramer, Matthijs
AU - Strnad, Pavel
AU - Tolba, Rene Hany
AU - Liu, Wenjia
AU - Keller, Theresa
AU - Miller, Hannah
AU - Pavicevic, Sandra
AU - Uluk, Deniz
AU - Kocik, Matej
AU - Lurje, Isabella
AU - Trautwein, Christian
AU - Mehrabi, Arianeb
AU - Popescu, Irinel
AU - Vondran, Florian Wolfgang Rudolf
AU - Ju, Cynthia
AU - Tacke, Frank
AU - Neumann, Ulf Peter
AU - Lurje, Georg
N1 - Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - OBJECTIVE: The aim of this study was to evaluate peak serum alanine aminotransferase (ALT) and postoperative clinical outcomes after hypothermic oxygenated machine perfusion (HOPE) versus static cold storage (SCS) in extended criteria donation (ECD) liver transplantation (LT) from donation after brain death (DBD).BACKGROUND: HOPE might improve outcomes in LT, particularly in high-risk settings such as ECD organs after DBD, but this hypothesis has not yet been tested in a randomized controlled clinical trial (RCT).METHODS: Between September 2017 and September 2020, 46 patients undergoing ECD-DBD LT from four centers were randomly assigned to HOPE (n = 23) or SCS (n = 23). Peak-ALT levels within 7 days following LT constituted the primary endpoint. Secondary endpoints included incidence of postoperative complications [Clavien-Dindo classification (CD), Comprehensive Complication Index (CCI)], length of intensive care- (ICU) and hospital-stay, and incidence of early allograft dysfunction (EAD).RESULTS: Demographics were equally distributed between both groups [donor age: 72 (IQR: 59-78) years, recipient age: 62 (IQR: 55-65) years, labMELD: 15 (IQR: 9-25), 38 male and 8 female recipients]. HOPE resulted in a 47% decrease in serum peak ALT [418 (IQR: 221-828) vs 796 (IQR: 477-1195) IU/L, P = 0.030], a significant reduction in 90-day complications [44% vs 74% CD grade ≥3, P = 0.036; 32 (IQR: 12-56) vs 52 (IQR: 35-98) CCI, P = 0.021], and shorter ICU- and hospital-stays [5 (IQR: 4-8) vs 8 (IQR: 5-18) days, P = 0.045; 20 (IQR: 16-27) vs 36 (IQR: 23-62) days, P = 0.002] compared to SCS. A trend toward reduced EAD was observed for HOPE (17% vs 35%; P = 0.314).CONCLUSION: This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation.
AB - OBJECTIVE: The aim of this study was to evaluate peak serum alanine aminotransferase (ALT) and postoperative clinical outcomes after hypothermic oxygenated machine perfusion (HOPE) versus static cold storage (SCS) in extended criteria donation (ECD) liver transplantation (LT) from donation after brain death (DBD).BACKGROUND: HOPE might improve outcomes in LT, particularly in high-risk settings such as ECD organs after DBD, but this hypothesis has not yet been tested in a randomized controlled clinical trial (RCT).METHODS: Between September 2017 and September 2020, 46 patients undergoing ECD-DBD LT from four centers were randomly assigned to HOPE (n = 23) or SCS (n = 23). Peak-ALT levels within 7 days following LT constituted the primary endpoint. Secondary endpoints included incidence of postoperative complications [Clavien-Dindo classification (CD), Comprehensive Complication Index (CCI)], length of intensive care- (ICU) and hospital-stay, and incidence of early allograft dysfunction (EAD).RESULTS: Demographics were equally distributed between both groups [donor age: 72 (IQR: 59-78) years, recipient age: 62 (IQR: 55-65) years, labMELD: 15 (IQR: 9-25), 38 male and 8 female recipients]. HOPE resulted in a 47% decrease in serum peak ALT [418 (IQR: 221-828) vs 796 (IQR: 477-1195) IU/L, P = 0.030], a significant reduction in 90-day complications [44% vs 74% CD grade ≥3, P = 0.036; 32 (IQR: 12-56) vs 52 (IQR: 35-98) CCI, P = 0.021], and shorter ICU- and hospital-stays [5 (IQR: 4-8) vs 8 (IQR: 5-18) days, P = 0.045; 20 (IQR: 16-27) vs 36 (IQR: 23-62) days, P = 0.002] compared to SCS. A trend toward reduced EAD was observed for HOPE (17% vs 35%; P = 0.314).CONCLUSION: This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation.
KW - Aged
KW - Allografts
KW - Equipment Design
KW - Europe/epidemiology
KW - Female
KW - Graft Survival
KW - Humans
KW - Hypothermia, Induced/instrumentation
KW - Incidence
KW - Liver Transplantation/methods
KW - Male
KW - Middle Aged
KW - Organ Preservation/instrumentation
KW - Perfusion/instrumentation
KW - Postoperative Complications/epidemiology
KW - Tissue Donors/supply & distribution
KW - machine perfusion
KW - STATIC COLD-STORAGE
KW - INDEX
KW - HOPE
KW - extended criteria donation
KW - MODEL
KW - PRESERVATION
KW - hypothermic oxygenated machine perfusion
KW - liver transplantation
U2 - 10.1097/SLA.0000000000005110
DO - 10.1097/SLA.0000000000005110
M3 - Article
C2 - 34334635
SN - 0003-4932
VL - 274
SP - 705
EP - 712
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -