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Liver preservation technique improves 5-year graft survival

Donation after circulatory death livers treated with hypothermic oxygenated perfusion had similar 5-year posttransplant outcomes as donation after brain death liver transplants and superior results to untreated donation after circulatory death livers, according to a study published in Journal of Hepatology.

“Donation after circulatory death (DCD) organs are increasingly used for liver transplantation, due to the persisting organ shortage and waiting list mortality,” Andrea Schlegel, MD, FEBS, from the University of Birmingham in the United Kingdom, and colleagues wrote. “However, several reports suggest inferior graft survival, increased risk of primary nonfunction (PNF), and biliary complications in DCD livers, with irreversible ischemic cholangiopathy (IC) being a major concern.”

To assess the preservation efficacy of hypothermic oxygenated perfusion (HOPE), Schlegel and colleagues matched 50 patients who received HOPE-treated DCD livers with 50 patients who received untreated DCD livers and 50 patients who received donation after brain death (DBD) livers.

Acute rejection occurred significantly more often among patients who received untreated DCD livers compared with HOPE-treated livers (P = .0019).

Seven grafts were lost among the untreated DCD liver group due to IC or primary non-function compared with none in the HOPE group (P = .0125).

Patients who received untreated livers were significantly more likely to experience graft loss due to any non-tumor related causes (32% vs. 8%) compared with the HOPE group (P = .005.), whereas the HOPE group’s graft survival rate was similar to patients who received DBD livers (10%).

At 5 years follow-up, graft survival was significantly higher in the HOPE group compared with the untreated DCD group (94% vs. 78%; P = .024) and similar to the DBD group.

“We suggest that the benefit of HOPE treatment is related to a primary antioxidative mitochondrial effect, subsequently leading to less reperfusion injury and improved early function,” Schlegel and colleagues wrote. “These results suggest that a simple, end-ischemic perfusion approach is highly effective and may open the field for safe utilization of extended DCD liver grafts.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.