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Publications

Journal Article Meta-Analysis Review Ppublish

PubMed: 42717689 DOI: 10.1111/ctr.70676

Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta- Analysis of Randomized Trials.

Clin Transplant 40(9):e70676

Authors: Ameni Ellouze, Stylianos Tzedakis, Mohamad Ali Zorkot, Xavier Giudicelli, Karim Boudjema, Heithem Jeddou

Affiliations

  • Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France.
  • Department of Hepato-biliary, Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Cité, Paris, France.
  • Irset (Institut De Recherche En santé, Environnement Et travail) -UMR_S 1085, Inserm, EHESP, Univ Rennes, Rennes, France.

Abstract

BACKGROUND

Hypothermic oxygenated machine perfusion (HOPE) is an alternative to static cold storage (SCS) for liver graft preservation, aiming to reduce ischemia-reperfusion injury (IRI) and improve post-transplant outcomes.

METHODS

We systematically reviewed randomized controlled trials (RCTs) comparing HOPE with SCS in adult liver transplantation (MEDLINE, EMBASE, CENTRAL to July 2026). Outcomes included early allograft dysfunction (EAD), primary non-function (PNF), major postoperative complications, biliary complications, including non-anastomotic strictures (NAS), graft survival, and retransplantation.

RESULTS

Eight RCTs (984 patients; HOPE 461; SCS 523) met inclusion criteria. HOPE significantly reduced EAD (17.8% vs. 33.5%; RR 0.54, 95% CI 0.43-0.68; p < 0.00001) and PNF (0.4% vs. 3.6%; RR 0.26, 95% CI 0.09-0.75; p = 0.01). HOPE was associated with fewer major complications (Clavien-Dindo ≥ III) (41.2% vs. 50.7%; RR 0.80, 95% CI 0.70-0.93; p = 0.003), lower overall biliary complications (18.9% vs. 27.7%; RR 0.72, 95% CI 0.58-0.90; p = 0.004) and reduced NAS (3.3% vs. 7.6%; RR 0.43, 95% CI 0.23-0.82; p = 0.01). One-year graft survival was comparable, while retransplantation was reduced after HOPE (RR 0.35, 95% CI 0.14-0.84, p = 0.02).

CONCLUSION

HOPE improves early graft outcomes and reduces biliary morbidity and retransplantation compared with SCS, supporting its use to mitigate IRI.

MeSH

Liver Transplantation, Cold Temperature, Graft Survival, Liver, Reperfusion Injury, Transplants, Transplantation