Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers

Otto B. van Leeuwen, Silke B. Bodewes, Veerle A. Lantinga, Martijn P.D. Haring, Adam M. Thorne, Isabel M.A. Brüggenwirth, Aad P. van den Berg, Marieke T. de Boer, Iris E.M. de Jong, Ruben H.J. de Kleine, Bianca Lascaris, Maarten W.N. Nijsten, Koen M.E.M. Reyntjens, Vincent E. de Meijer*, Robert J. Porte*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Ex situ normothermic machine perfusion (NMP) is increasingly used for viability assessment of high-risk donor livers, whereas dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury. We aimed to resuscitate and test the viability of initially-discarded, high-risk donor livers using sequential DHOPE and NMP with two different oxygen carriers: an artificial hemoglobin-based oxygen carrier (HBOC) or red blood cells (RBC). In a prospective observational cohort study of 54 livers that underwent DHOPE-NMP, the first 18 procedures were performed with a HBOC-based perfusion solution and the subsequent 36 procedures were performed with an RBC-based perfusion solution for the NMP phase. All but one livers were derived from extended criteria donation after circulatory death donors, with a median donor risk index of 2.84 (IQR 2.52–3.11). After functional assessment during NMP, 34 livers (63% utilization), met the viability criteria and were transplanted. One-year graft and patient survival were 94% and 100%, respectively. Post-transplant cholangiopathy occurred in 1 patient (3%). There were no significant differences in utilization rate and post-transplant outcomes between the HBOC and RBC group. Ex situ machine perfusion using sequential DHOPE-NMP for resuscitation and viability assessment of high-risk donor livers results in excellent transplant outcomes, irrespective of the oxygen carrier used.

Original languageEnglish
Pages (from-to)1658-1670
Number of pages13
JournalAmerican Journal of Transplantation
Issue number6
Publication statusPublished - Jun 2022

Bibliographical note

Publisher Copyright:
© 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.


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