Introduction: Corroborating evidence for use of hypothermic oxygenated machine perfusion (HOPE) prior to liver transplantation (OLT) suggests a beneficial effect in regards to biliary complications. Here, we aim to evaluate whether perfusion via portal vein alone (sHOPE) or via additional perfusion of the hepatic artery (dHOPE) has diverging impact on outcome after OLT.
Method: Consecutive patients undergoing OLT at Medical University of Vienna between 2018 and 2023 were retrospectively analyzed. Donor organs were procured using static cold storage (SCS), or subjected to end-ischemic sHOPE or dHOPE. In-hospital course and post-discharge visits at the department’s outpatient clinic were documented. Patients were followed for development of biliary complications. Severity of biliary complications was classified according to degree of therapeutic intervention (i.e., endoscopic retrograde cholangiopancreatography [ERCP] or surgical revision).
Results: 247 patients were included (69 SCS, 76 sHOPE, 102 dHOPE). Hospitalization was shorter for patients after HOPE (median in days: SCS=25 vs HOPE=20, p=0.019). Biliary complications were less frequent in patients after HOPE (37.7% vs 22.5%, p=0.015). A significantly lower incidence of surgical revisions for biliary complications was observed in the HOPE cohort (24.6% vs 11.8%, p=0.012), while no difference in frequency of interventional ERCP was observed (p=0.535). Interestingly, only dHOPE was significantly associated with reduced surgical revisions for biliary complications upon uni- and multivariable logistic regression (odds ratio = 0.336, p=0.011). Ultimately, patients undergoing HOPE displayed prolonged time to first biliary complication. However, there were no differences in graft survival and rate of retransplantation (p=0.783).
Conclusion: HOPE leads to a reduction of biliary complications and associated surgical revisions. The effect on reduction of surgical revisions seems to be stronger for use of dHOPE, while both methods seem to be feasible options for preconditioning of donor grafts prior to OLT.