Hypothermic machine perfusion in liver transplantation — A randomized trial

[en] Transplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited. METHODS In this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications. RESULTS A total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups. CONCLUSIONS Hypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage. (Funded by Fonds NutsOhra; DHOPE-DCD ClinicalTrials.gov number, NCT02584283). Copyright © 2021 Massachusetts Medical Society.

Disciplines :

Surgery

Author, co-author :

van Rijn, Rianne; Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands

Schurink, Ivo J; Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands ; Department of Surgery, Leiden University Medical Center, Leiden, Netherlands

de Vries, Yvonne; Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands

van den Berg, Aad P; Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands

Cerisuelo, Miriam Cortes; Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London, United Kingdom

Murad, Sarwa Darwish; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands ; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands

Erdmann, Joris I

Gilbo, NICHOLAS ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation

de Haas, Robbert J; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Heaton, Nigel; Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London, United Kingdom

More authors (12 more)

Language :

English

Title :

Hypothermic machine perfusion in liver transplantation — A randomized trial

Publication date :

2021

Journal title :

New England Journal of Medicine

ISSN :

0028-4793

eISSN :

1533-4406

Publisher :

Massachussetts Medical Society

Volume :

384

Issue :

Pages :

1391 - 1401

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 25 January 2024

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