Hypothermic oxygenated perfusion improves DCD livers for transplantation
Hypothermic oxygenated perfusion (HOPE)-treated human livers donated after circulatory death (DCD) show superior function over untreated livers, a new study has shown.
Researchers evaluated 50 HOPE-treated DCD, 50 donated after brain death (DBD) and 50 untreated DCD liver transplants. Study endpoints included post-transplant complications, nontumour related patient death and graft loss.
Untreated DCD livers required significantly more median transfusions of fresh frozen plasma (6 vs 0; p<0.0001) during operation despite a comparable duration of surgery. HOPE-treated DCD transplants also resulted in a significantly lower lactate level at the end of the transplantation procedure (p<0.0001).
International normalized ratio (INR)1 day after transplantation was likewise significantly reduced in those who received the HOPE-treated DCD livers (p<0.0001). These findings indicated superior function over untreated transplants. There was no between-group difference in peak 7-day alanine aminotransferase release.
In terms of complications, acute rejections were significantly more common in untreated DCD livers relative to HOPE-treated transplants (p=0.0019). Median alkaline phosphatase levels 6 months after the procedure were similarly significantly lower in those who received the treated livers (p=0.049).
Seven cases of graft loss were reported in the untreated DCD group, which was significantly greater than that in the HOPE-treated transplant group (n=0; p=0.0125). Ischaemic cholangiopathy and primary nonfunction were the reasons for graft loss.
Five-year graft survival rates for the untreated and HOPE-treated DCD livers were 74 percent and 94 percent, respectively. HOPE-treated transplants demonstrated comparable overall survival compared with DBD controls.