Hypothermic Oxygenated Machine Perfusion (HOPE) Prior to Liver Transplantation Mitigates Post-Reperfusion Syndrome and Perioperative Electrolyte Shifts

Abstract

(1) Background: Post-reperfusion syndrome (PRS) and electrolyte shifts (ES) represent considerable challenges during liver transplantation (LT) being associated with significant morbidity. We aimed to investigate the impact of hypothermic oxygenated machine perfusion (HOPE) on PRS and ES in LT. (2) Methods: In this retrospective study, we compared intraoperative parameters of 100 LTs, with 50 HOPE preconditioned liver grafts and 50 grafts stored in static cold storage (SCS). During reperfusion phase, prospectively registered serum parameters and vasopressor administration were analyzed. (3) Results: Twelve percent of patients developed PRS in the HOPE cohort vs. 42% in the SCS group (p = 0.0013). Total vasopressor demand in the first hour after reperfusion was lower after HOPE pretreatment, with reduced usage of norepinephrine (−26%; p = 0.122) and significant reduction of epinephrine consumption (−52%; p = 0.018). Serum potassium concentration dropped by a mean of 14.1% in transplantations after HOPE, compared to a slight decrease of 1% (p < 0.001) after SCS. The overall incidence of early allograft dysfunction (EAD) was reduced by 44% in the HOPE group (p = 0.04). (4) Conclusions: Pre-transplant graft preconditioning with HOPE results in higher hemodynamic stability during reperfusion and lower incidence of PRS and EAD. HOPE has the potential to mitigate ES by preventing hyperpotassemic complications that need to be addressed in LT with HOPE-pre-treated grafts.

Hypothermic oxygenated perfusion in liver transplantation: a meta-analysis of randomized controlled trials and matched studies

“…Therefore, further studies are required to confirm the effect of HOPE on long-term patient prognosis. Similarly, a retrospective non-PSM study 26 of 100 liver transplant recipients showed that HOPE reduced the incidence of EAD by 44%. Patrono et al .…”

“…1 ). The four excluded unmatched studies 24 – 27 (three 24 – 26 did not use the matching method and one 27 used inverse probability of treatment weighting, but no post-inverse probability of treatment weighting data were available; even after contacting the corresponding author of the study, no data were available, so this study was classified as a unmatched study) are summarized in Supplementary Table S1 (Supplemental Digital Content 4, http://links.lww.com/JS9/B67 ).…”

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

“…Besides, CIT is related to PRS [ 12 ] and IRI which are known risk factors for graft loss [ 13 ]. HOPE has been shown to improve graft preservation by actively oxygenating the graft associated with shorter CIT [ 8 ], translating into decreased PRS [ 10 , 25 , 26 ], decreased EAD, ischemic type biliary complications and graft loss [ 11 ] in adult LT. In our institution, we therefore implemented HOPE for ex-situ split liver grafts since 2020 aiming at improving graft preservation in PSLT.…”

“…These clinical observations are supported by experimental data showing a reduction of mitochondrial damage with HOPE which translates into a reduction of the hepatic inflammasome [ 27 , 28 ]. Indeed, HOPE replaces cold ischemia by an active oxygenation of the graft during preservation thus improving mitochondrial function, uploading the ATP cellular pool [ 28 , 29 ] and mitigating IRI [ 10 , 25 , 26 ]. Applying HOPE during ex-situ liver splitting thus combines the benefit of shorter CIT, inherent to this strategy, to mitochondrial metabolism recovery.…”

Establishing a HOPE Program in a Real-life Setting: A Brazilian Case Series

“…MP is expected to increase the pool of transplantable organs. 4,24 Nevertheless, implementing this technology outside the controlled environment of RCT. is full of challenges imposed by clinical practice.…”