Real-World Analysis of Hypothermic Oxygenated Perfusion and Normothermic Machine Perfusion in Liver Transplantation: An International Cohort Study.
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Pfister Matthias, Eden Janina, Rasel Hannah, Abbassi Fariba, Störzer Simon, Botea Florin, Buchholz Bettina M, Novoa Francisco C, Camagni Stefania, Chapman William C, Cillo Umberto, Cimeno Arielle, Compagnon Philippe, Cortes-Cerisuelo Miriam, Cortez Alexander R, Croome Kris P, De Carlis Riccardo, Diogo Dulce, Di Benedetto Fabrizio, Dondossola Daniele, Fung John, Fronek Jiri, Garcia Carlos, Györi Georg, Hamilton Matthew, Heimbach Julie K, Houben Philipp, Koliogiannis Dionysios, Kubal Chandrashekhar A, Lam Hwai-Ding, Lunow-Luke Tyler, Lurje Georg, Mahenthiran Ajay, Monbaliu Diethard, Nassar Hussein, Pascher Andreas, Patel Madhukar S, Patrono Damiano, Porte Robert J, Prommegger Lukas, Punjala Rithin, Ravaioli Matteo, Rayar Michel, Roberts John P, Roll Garrett R, Satish Sangeeta, Schlegel Andrea, Schmelzle Moritz, Schneeberger Stefan, Selzner Markus, Shapiro James, Sörensen Gustaf, Vachharajani Neeta, Vagefi Parsia, Washburn W Kenneth, Pinna Antonio, Dutkowski Philipp, de Meijer Vincent E, Clavien Pierre-Alain, Real-World Liver Perfusion Consortium
Аннотация
SUMMARY BACKGROUND DATA: Real-world comparisons between HOPE and NMP are limited and methodologically challenging due to heterogeneity in donor and recipient risk profiles and regional differences in practice patterns.
METHODS: This international cohort study analyzed consecutive NMP-preserved LTs performed at 15 predominantly North American centers between 2021 and 2025. Outcomes were compared with the European HOPE-REAL cohort, comprising HOPE-treated LTs from 22 centers between 2012 and 2021. Risk-adjusted analyses were performed, stratified by graft type and risk category. Imbalances in baseline characteristics were addressed using entropy balancing.
RESULTS: A total of 954 NMP-treated and 1202 HOPE-treated grafts were analyzed, revealing substantial differences in donor risk. Extended-criteria DBD grafts accounted for 30% versus 64%, and futile DCD grafts for 10% versus 30%, in the NMP and HOPE cohorts, respectively. In the NMP cohort, death-censored graft survival at 1, 2, and 3 years exceeded 96% for DBD grafts and 94% for DCD grafts. Comparable outcomes were observed in the HOPE cohort, with 93% survival in DBD and 87% in DCD grafts at up to 3 years, despite significantly higher donor risk in the HOPE-DCD cohort. After risk adjustment, death-censored graft survival remained similar between both modalities across graft types and risk categories.
CONCLUSIONS: Real-world data on HOPE-treated and NMP-treated LT demonstrate excellent outcomes. Nevertheless, compared with HOPE, further high-quality evidence and longer preservation time is needed to substantiate the clinical benefits of NMP in high-risk grafts.