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Publications

Journal Article Ahead of print

PubMed: 42684111 DOI: 10.1097/SLA.0000000000007195

Real-World Analysis of Hypothermic Oxygenated Perfusion and Normothermic Machine Perfusion in Liver Transplantation: An International Cohort Study.

Ann Surg

Authors: Matthias Pfister, Janina Eden, Hannah Rasel, Fariba Abbassi, Simon Störzer, Florin Botea, Bettina M Buchholz, Francisco C Novoa, Stefania Camagni, William C Chapman, Umberto Cillo, Arielle Cimeno, Philippe Compagnon, Miriam Cortes-Cerisuelo, Alexander R Cortez, Kris P Croome, Riccardo De Carlis, Dulce Diogo, Fabrizio Di Benedetto, Daniele Dondossola, John Fung, Jiri Fronek, Carlos Garcia, Georg Györi, Matthew Hamilton, Julie K Heimbach, Philipp Houben, Dionysios Koliogiannis, Chandrashekhar A Kubal, Hwai-Ding Lam, Tyler Lunow-Luke, Georg Lurje, Ajay Mahenthiran, Diethard Monbaliu, Hussein Nassar, Andreas Pascher, Madhukar S Patel, Damiano Patrono, Robert J Porte, Lukas Prommegger, Rithin Punjala, Matteo Ravaioli, Michel Rayar, John P Roberts, Garrett R Roll, Sangeeta Satish, Andrea Schlegel, Moritz Schmelzle, Stefan Schneeberger, Markus Selzner … and 9 other authors

Affiliations

  • Department of Surgery and Transplantation, University of Zurich, Zurich, Switzerland.
  • Hub for Translational Research and Liver/GI Health, University of Zurich, University of Fribourg, Federal Institute of Technology Zurich, Switzerland.
  • Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
  • Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
  • Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
  • Fundeni Clinical Institute, Center of General Surgery and Liver Transplantation; "Titu Maiorescu" University, Bucharest, Romania.
  • Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Department of Surgery, University of Toronto, Toronto, Canada.
  • Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Department of Surgery, Section of Abdominal Organ Transplant, Washington University School of Medicine, St. Louis, MO.
  • Chirurgia Generale 2, Hepato-Biliary-Pancreatic Unit and Liver Transplant Center, Padova University Hospital, Padova, Italy.
  • Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, IL.
  • Department of Transplant Surgery, University of Geneva, Geneva, Switzerland.
  • Institute of Liver Studies, King's College Hospital, London, United Kingdom.
  • Division of Transplant Surgery, Mayo Clinic Rochester, Rochester, NY.
  • Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
  • Department of Hepatic Surgery and Liver and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Italy.
  • Department of Surgery and Gastroenterology, Adult Liver Transplantation Unit, Coimbra Hospital and University Center, Coimbra, Portugal.
  • Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
  • Department of Pathophysiology and Transplantation, General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
  • Department of Transplant Surgery, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
  • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
  • Division of Transplantation, Medical University of Vienna, Vienna, Austria.
  • Department of Surgery, Comprehensive Transplant Center, Ohio State University Wexner Medical Center, Columbus, OH.
  • Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany.
  • Department of Transplant Surgery, University of Munich Grosshadern, Germany.
  • Indiana University School of Medicine, Indianapolis, IN.
  • Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
  • Department of Surgery, University of California San Francisco, San Francisco, CA.
  • Department of Gastroenterology and Hepatology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Abdominal Transplantation, Leuven Transplant Center, University Hospitals Leuven, Leuven, Belgium.
  • Department of Surgery, Division of Surgical Transplantation, UT Southwestern Medical Center, Dallas, TX.
  • General Surgery 2U, Liver Transplant Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
  • Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Division of HPB and Transplant Surgery, Rotterdam, The Netherlands.
  • Department of Visceral, Transplant and Thoracic Surgery, OrganLife Organ Regeneration Center of Excellence, Medical University of Innsbruck, Innsbruck, Austria.
  • Department of General Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy.
  • CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.
  • Transplantation Center and Lerner Research Institute, Cleveland Clinic, OH.

Abstract

OBJECTIVE

To report real-world data on hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP) in liver transplantation (LT).

SUMMARY BACKGROUND DATA

Real-world comparisons between HOPE and NMP are limited and methodologically challenging due to heterogeneity in donor and recipient risk profiles and regional differences in practice patterns.

METHODS

This international cohort study analyzed consecutive NMP-preserved LTs performed at 15 predominantly North American centers between 2021 and 2025. Outcomes were compared with the European HOPE-REAL cohort, comprising HOPE-treated LTs from 22 centers between 2012 and 2021. Risk-adjusted analyses were performed, stratified by graft type and risk category. Imbalances in baseline characteristics were addressed using entropy balancing.

RESULTS

A total of 954 NMP-treated and 1202 HOPE-treated grafts were analyzed, revealing substantial differences in donor risk. Extended-criteria DBD grafts accounted for 30% versus 64%, and futile DCD grafts for 10% versus 30%, in the NMP and HOPE cohorts, respectively. In the NMP cohort, death-censored graft survival at 1, 2, and 3 years exceeded 96% for DBD grafts and 94% for DCD grafts. Comparable outcomes were observed in the HOPE cohort, with 93% survival in DBD and 87% in DCD grafts at up to 3 years, despite significantly higher donor risk in the HOPE-DCD cohort. After risk adjustment, death-censored graft survival remained similar between both modalities across graft types and risk categories.

CONCLUSIONS

Real-world data on HOPE-treated and NMP-treated LT demonstrate excellent outcomes. Nevertheless, compared with HOPE, further high-quality evidence and longer preservation time is needed to substantiate the clinical benefits of NMP in high-risk grafts.

MeSH

Liver Transplantation, Cohort Studies, Graft Survival, Liver, Transplants, General Surgery, Transplantation