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

Abstract

Prompted by the utilization of extended criteria donors, dual hypothermic oxygenated machine perfusion (D-HOPE) was introduced in liver transplantation to improve preservation. When donors after neurological determination of death (DBD) are used, D-HOPE effect on graft outcomes is unclear. To assess D-HOPE value in this setting and to identify ideal scenarios for its use, data on primary adult liver transplant recipients from January 2014 to April 2021 were analyzed using inverse probability of treatment weighting, comparing outcomes of D-HOPE-treated grafts (n = 121) with those preserved by static cold storage (n = 723). End-ischemic D-HOPE was systematically applied since November 2017 based on donor and recipient characteristics and transplant logistics. D-HOPE use was associated with a significant reduction of early allograft failure (OR: 0.24; 0.83; p = .024), grade ≥3 complications (OR: 0.57; p = .046), comprehensive complication index (-7.20 points; p = .003), and improved patient and graft survival. These results were confirmed in the subset of elderly donors (>75-year-old). Although D-HOPE did not reduce the incidence of biliary complications, its use was associated with a reduced severity of ischemic cholangiopathy. In conclusion, D-HOPE improves postoperative outcomes and reduces early allograft loss in extended criteria DBD grafts.

Keywords: clinical research / practice; health services and outcomes research; liver transplantation / hepatology; organ allocation; organ perfusion and preservation; organ procurement; organ procurement and allocation.

© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

FIGURE 1

Hierarchical representation of indications for D‐HOPE. Circles size is proportional to the frequency of each indication. In the source table, data are presented as number (percentage) or median (interquartile range) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Covariate balance in the whole cohort and in the elderly donors (≥ 75‐year‐old) subset. The vertical dotted line represents the 0.15 cutoff of absolute standardized mean difference [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Spider plots representing D‐HOPE effect on relevant endpoints in the whole cohort and in the elderly donor subset. For dichotomous variables, dots on each radial axis represent the adjusted incidence rate on a scale from 0% to 40%. For continuous variables, dots represent the adjusted median value, and minimum and maximum radial axis points correspond to the 25% and 75% percentile. Variables for which the difference between SCS (red dots) and D‐HOPE (blue dots) was significant are marked with an asterisk. EAF, early allograft failure; CCI, comprehensive complication index; AKI, acute kidney injury; L‐GrAFT, liver graft assessment following transplantation score; IC, ischemic cholangiopathy [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Raw and IPTW‐adjusted patient and graft Kaplan‐Meier survival curves in the whole cohort [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 5

Raw and IPTW‐adjusted patient and graft Kaplan‐Meier survival curves in the elderly donors (≥75‐year‐old) subset [Color figure can be viewed at wileyonlinelibrary.com]