Economic Evaluation of Prolonged Hypothermic Oxygenated Machine Perfusion Enabling Daytime Liver Transplantation

BACKGROUND: Short-duration (1-2 h) dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury-related complications. Prolonged DHOPE preservation (DHOPE-PRO) may facilitate logistics. We assessed the economic impact of DHOPE-PRO versus conventional short-duration DHOPE, hypothesizing that DHOPE-PRO would not be associated with increased one-year transplantation-related costs. METHODS: This post hoc economic evaluation of the prospective DHOPE-PRO trial (NL8740) included adult recipients of livers donated after brain death. All transplantation-related medical expenses up to one year post-transplant were collected. The cost of resource use was calculated using 2022 full hospital prices indexed to 2024. Time-driven variable costing was applied to perfusion, surgery, and intensive care costs. The primary outcome was total one-year transplantation-related cost. RESULTS: Of 24 patients, 12 received a liver after DHOPE and 12 after DHOPE-PRO. Median one-year total costs were €83 583 [interquartile range (IQR) 78 400-104 158] for DHOPE and €78 582 [IQR 73123-92 855] for DHOPE-PRO (p = 0.347). Perfusion costs were higher with DHOPE-PRO (€23 926 [IQR 22711-24 697] versus €17 306 [IQR 16928-17 594]; p < 0.001), while surgery costs were lower (€18 560 [IQR 17806-20 747] versus €21 303 [IQR 19535-25 418]; p = 0.033). Costs related to other medical activities did not differ between groups. CONCLUSION: In this exploratory single-center economic evaluation, DHOPE-PRO enabled daytime liver transplantation without evidence of increased one-year transplantation-related costs compared with short-duration DHOPE. Higher perfusion-related costs were accompanied by lower surgery-related costs in this cohort. These findings warrant confirmation in larger studies. TRIAL REGISTRATION: Netherlands Trial Registry number: NL8740.