NEW YORK (Reuters Health) - Extended criteria donor livers treated with dual hypothermic oxygenated machine perfusion (D-HOPE) have lower rates of graft failure and are associated with fewer post operative complications in recipients, researchers report.
In a single center study published in the American Journal of Transplantation, Dr. Damiano Patrono and colleagues at University of Turin, Italy reviewed data on 121 livers from extended-criteria brain-dead donors that were treated with D-HOPE (oxygenated perfusion through both the portal vein and hepatic artery) for a minimum of 90 minutes after removal from cold storage. Extended criteria included age >80, age >70 with additional risk factors, or grafts of any age with significant steatosis.
Compared to recipients of 723 livers from extended-criteria donors that were preserved with cold storage alone, recipients of grafts treated with D-Hope had significantly lower rates of early graft failure (2.65% vs 9.6%) and Grade 3 Clavien-Dindo complications (17.4% vs 24.9%) and showed a trend toward a lower risk for acute kidney injury. Ischemic cholangiopathy was found to be less severe in D-Hope recipients.
Of the three cases of early graft failure in the D-HOPE group, two were from donors with 30% and 40% macrosteatosis, suggesting caution when using livers with significant macrovesicular fat.
