Are there any benefits of prolonged hypothermic oxygenated perfusion?: Results from a national retrospective study

Dual hypothermic oxygenated perfusion (DHOPE) is increasingly being used to extend liver preservation to improve transplant logistics. However, little is known about its benefits in high-risk liver grafts. This study aimed to investigate whether prolonged DHOPE provides benefits other than improved logistics in all liver types. We performed a national retrospective cohort study of 177 liver transplants from 12 Italian centers preserved with DHOPE for ≥4 hours between 2015 and 2022. A control group of 177 DHOPEs of <4 hours during the same period was created using 1:1 propensity score matching. The impact of risk profiles and preservation times on the outcomes was assessed using univariable and multivariable regression models. No significant differences in posttransplant outcomes were found between prolonged and short DHOPEs. However, the prolonged group had a significantly lower incidence of posttransplant acute kidney injury (AKI) compared to the short group (30.5% vs. 44.6%, p = 0.008). Among prolonged DHOPEs, no differences in transplant outcomes were observed according to donor risk index, Eurotransplant definition for marginal grafts, and balance of risk score. DHOPE duration was associated with a lower risk of AKI in multivariable models adjusted for donor risk index, Eutrotransplant marginal grafts, and balance of risk score. Prolonged hypothermic oxygenated perfusion confirmed its protective effect against AKI in a multivariable model adjusted for donor and recipient risk factors [OR: 0.412, 95% CI: 0.200-0.850, p = 0.016]. Prolonged DHOPE is widely used to improve transplant logistics, provides good results with high-risk grafts, and appears to be associated with a lower risk of posttransplant AKI. These results provide further insight into the important role of DHOPE in preventing posttransplant complications.

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Publication Details

Journal
Liver Transplantation
Published
2024-09-17
DOI
https://doi.org/10.1097/lvt.0000000000000476
Citations
6
Primary Topic
Liver Disease and Transplantation
Type
article
Field-Weighted Citation Impact
2.22
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article

Are there any benefits of prolonged hypothermic oxygenated perfusion?: Results from a national retrospective study

Davide Ghinolfi, Enrico Gringeri, Renato Romagnoli, Fabrizio Di Benedetto et al.
6 citations
Liver Transplantation
Liver Disease and Transplantation
2.22
article

Are there any benefits of prolonged hypothermic oxygenated perfusion?: Results from a national retrospective study

Davide Ghinolfi, Enrico Gringeri, Renato Romagnoli, Fabrizio Di Benedetto, Enzo Andorno, Umberto Cillo, Duilio Pagano, Matteo Cescon, Luciano De Carlis, Damiano Patrono, Marco Bongini, Salvatore Gruttadauria, Daniele Dondossola, Andrea Schlegel, Domenico Pinelli, Davide Paolo Bernasconi, Tiziana Olivieri, Vincenzo Mazzaferro, Andrea Lauterio, Stefania Camagni, Paolo Montanelli, Umberto Baccarani, Matteo Ravaioli, L. Caccamo, Maria Grazia Valsecchi, Riccardo De Carlis, Daniele Pezzati
article en
6 citations

Abstract

Dual hypothermic oxygenated perfusion (DHOPE) is increasingly being used to extend liver preservation to improve transplant logistics. However, little is known about its benefits in high-risk liver grafts. This study aimed to investigate whether prolonged DHOPE provides benefits other than improved logistics in all liver types. We performed a national retrospective cohort study of 177 liver transplants from 12 Italian centers preserved with DHOPE for ≥4 hours between 2015 and 2022. A control group of 177 DHOPEs of <4 hours during the same period was created using 1:1 propensity score matching. The impact of risk profiles and preservation times on the outcomes was assessed using univariable and multivariable regression models. No significant differences in posttransplant outcomes were found between prolonged and short DHOPEs. However, the prolonged group had a significantly lower incidence of posttransplant acute kidney injury (AKI) compared to the short group (30.5% vs. 44.6%, p = 0.008). Among prolonged DHOPEs, no differences in transplant outcomes were observed according to donor risk index, Eurotransplant definition for marginal grafts, and balance of risk score. DHOPE duration was associated with a lower risk of AKI in multivariable models adjusted for donor risk index, Eutrotransplant marginal grafts, and balance of risk score. Prolonged hypothermic oxygenated perfusion confirmed its protective effect against AKI in a multivariable model adjusted for donor and recipient risk factors [OR: 0.412, 95% CI: 0.200-0.850, p = 0.016]. Prolonged DHOPE is widely used to improve transplant logistics, provides good results with high-risk grafts, and appears to be associated with a lower risk of posttransplant AKI. These results provide further insight into the important role of DHOPE in preventing posttransplant complications.

Liver TransplantationVol. 31(1)
University of Pisa (IT), University of Modena and Reggio Emilia (IT), University of Udine (IT), Cleveland Clinic (US), University of Padua (IT), University of Milan (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Cleveland Clinic Lerner College of Medicine (US), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Ospedale Papa Giovanni XXIII (IT), Ospedale Policlinico San Martino (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Artistic Realization Technologies (US), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Turin (IT), University of Milano-Bicocca (IT)
Openalex Percentile: Top 12%
Liver Disease and Transplantation
2.22
DOISourceOpenAlex
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