Long-term Follow-up After Hypothermic Oxygenated Machine Perfusion in DCD Liver Transplantation: Results of a Randomized Controlled Multicenter Trial (DHOPE-DCD).
van Rijn, R., et al.Ann Surg. 2025 Nov 1;282(5):717-724.
Aims
The aim of this study was to investigate the 5-year outcomes following transplantation of donation after circulatory death (DCD) livers that undwerwent dual hypothermic oxygenated perfusion (DHOPE), focusing particularly on the incidence of nonanastomotic biliary strictures (NAS) and acute cellular rejection (ACR).
Interventions
DCD livers were randomised to either the DHOPE machine perfusion group or the standard static cold storage group.
Participants
156 patients that received DCD liver transplantation.
Outcomes
The primary outcome was the 5-year incidence of symptomatic NAS. The secondary outcomes included the incidence of ACR, patient survival and graft survival.
Follow-up
5 years posttransplantation
CET Conclusions
This paper reports 5-year outcomes from the European study of dual oxygenated hypothermic machine perfusion (D-HOPE) in DCD liver transplantation. The authors report that incidence of non-anastomotic strictures remained lower at 5 years post-transplant in the D-HOPE group (26% vs. 14%). Incidence of acute cellular rejection (ACR) was also reported as lower, but only in high-risk patients (with immune mediated liver diseases), in the D-HOPE group. There was no difference in patient or graft survival at 5 years. These results are encouraging, confirming a benefit of D-HOPE in DCD livers in long-term follow-up. Completeness of follow-up is good, with only 3 patients lost to follow-up (although the authors do not report which group(s) these patients were in). The findings on the incidence of ACR are interesting and warrant further study but are in keeping with those seen with HOPE in the kidney setting.
Trial registration
ClinicalTrials.gov - NCT02584283