Hypothermic Oxygenated Machine Perfusion Using a Standard Cardiopulmonary Bypass System: Clinical Outcomes and Feasibility in Extended Criteria Donor Liver Transplantation.

OBJECTIVES

Hypothermic oxygenated perfusion reduces ischemia-reperfusion injury and improves early graft function in extended criteria donor liver transplant. However, use of machine perfusion may be limited because of lack of dedicated perfusion devices. We evaluated feasibility and clinical outcomes of dual hypothermic oxygenated perfusion performed using a standard cardiopulmonary bypass system.

MATERIALS AND

METHODS

We retrospectively analyzed 87 adult recipients who underwent orthotopic liver transplant from extended criteria donors (2018 -2024 ). We compared 34 cases with static cold storage (SCS group; 2018 -2022 ) versus 53 with dual hypothermic oxygenated perfusion using a modified cardiopulmonary bypass system (D -HOPE group; 2023 -2024 ), analyzing early graft function, early allograft dysfunction, postoperative renal function, complications, and short -term survival. Morphological assessment included light and transmission electron microscopy at 3 time points: before preservation, after dual hypothermic oxygenated perfusion, and after static cold storage.

RESULTS

Dual hypothermic oxygenated perfusion was associated with significantly lower aspartate aminotransferase on postoperative day 1 (1450 {1180 -2210 }vs 2280 {1620 -3010 } U /L; P = . ⁰ ³ ³ ) and alanine aminotransferase (1180 {900 -2002 } vs 1890 {1280 -2500 } U /L; P = . ⁰ ² ⁴ ). Total bilirubin and international normalized ratio were significantly lower on postoperative days 3 and 7. Early allograft dysfunction occurred in 28.3 % of patients in the D -HOPE and 61.8 % in the SCS group (P = . ⁰ ). Reduced estimated glomerular filtration rate ( <45 mL /min /1.73 m ² ⁰ ⁴ ) was less frequent and total intensive care unit and hospital stay were significantly shorter in the D-HOPE group. Electron microscopy demonstrated better preservation of mitochondrial ultrastructure after dual hypothermic oxygenated perfusion, whereas light histology showed comparable findings across groups.

CONCLUSIONS

Dual hypothermic oxygenated perfusion performed with a standard cardiopulmonary bypass system is feasible and safe and associated with improved early graft function in extended criterial donor liver transplant. This conventional platform may facilitate hypothermic oxygenated perfusion in transplant centers lacking dedicated machine perfusion systems.