Outcomes of hypothermic hyperoxygenated perfusion compared to static cold storage for liver transplant. A systematic review and meta-analysis of randomized clinical trials

While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation. Following PRISMA guidelines, a systematic review was performed to determine the impact of Hypothermic Oxygenated Perfusion (HOPE) on liver transplant outcomes compare...

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Published inJournal of liver transplantation Vol. 15; p. 100226
Main Authors Cordova, Mario A. O'Connor, Ortega-Macias, Alan G., Altamirano, Francisco, Hoyos, Maria E., Gonzalez-Zorrilla, Fernando
Format Journal Article
LanguageEnglish
Published Elsevier Masson SAS 01.08.2024
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Abstract While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation. Following PRISMA guidelines, a systematic review was performed to determine the impact of Hypothermic Oxygenated Perfusion (HOPE) on liver transplant outcomes compared to static cold storage (SCS). A total of five studies were included, totaling 586 patients, out of which 267 patients had HOPE-preserved grafts and 319 SCS-preserved grafts. Analysis showed a significant decrease in early graft dysfunction and biliary complications in the HOPE group when compared to SCS (RR = 0.52; 95 % CI = 0.33–0.81]; p = 0.01) (RR = 0.75; 95 % CI = [0.60–0.94]; p = 0.02), respectively. Similarly, non-anastomotic biliary strictures were significantly reduced in the HOPE group (RR = 0.41; 95 % CI = [0.20–0.86]; p = 0.03). Of note, no statistical significance was found on the one-year graft loss and recipient death (RR = 0.40; 95 % CI = [0.09–1.83]; p = 0.12 and RR = 0.62; 95 % CI = [0.29–1.32]; p = 0.14, respectively). Likewise, no statistical difference was evident in acute rejection (RR = 0.54; 95 % CI = [0.04–7.14]; p = 0.20) and postreperfusion syndrome rate (RR = 0.92; 95 % CI = [0.35–2.41]; p = 0.73). After statistical analysis, no significant differences in major complications, primary nonfunction, re-transplantation, hepatic artery thrombosis, need for renal replacement therapy, intensive care unit, and hospital length of stay were evident. Liver preservation techniques are gaining popularity by enabling rescue and transplantation of marginal livers. In this study, HOPE showed statistically significant differences in reducing rates of biliary complications, biliary stricture, and early graft dysfunction. Further studies are needed to evaluate financial burden and long-term outcomes to completely elucidate the impact of this organ preservation technique.
AbstractList While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation. Following PRISMA guidelines, a systematic review was performed to determine the impact of Hypothermic Oxygenated Perfusion (HOPE) on liver transplant outcomes compared to static cold storage (SCS). A total of five studies were included, totaling 586 patients, out of which 267 patients had HOPE-preserved grafts and 319 SCS-preserved grafts. Analysis showed a significant decrease in early graft dysfunction and biliary complications in the HOPE group when compared to SCS (RR = 0.52; 95 % CI = 0.33–0.81]; p = 0.01) (RR = 0.75; 95 % CI = [0.60–0.94]; p = 0.02), respectively. Similarly, non-anastomotic biliary strictures were significantly reduced in the HOPE group (RR = 0.41; 95 % CI = [0.20–0.86]; p = 0.03). Of note, no statistical significance was found on the one-year graft loss and recipient death (RR = 0.40; 95 % CI = [0.09–1.83]; p = 0.12 and RR = 0.62; 95 % CI = [0.29–1.32]; p = 0.14, respectively). Likewise, no statistical difference was evident in acute rejection (RR = 0.54; 95 % CI = [0.04–7.14]; p = 0.20) and postreperfusion syndrome rate (RR = 0.92; 95 % CI = [0.35–2.41]; p = 0.73). After statistical analysis, no significant differences in major complications, primary nonfunction, re-transplantation, hepatic artery thrombosis, need for renal replacement therapy, intensive care unit, and hospital length of stay were evident. Liver preservation techniques are gaining popularity by enabling rescue and transplantation of marginal livers. In this study, HOPE showed statistically significant differences in reducing rates of biliary complications, biliary stricture, and early graft dysfunction. Further studies are needed to evaluate financial burden and long-term outcomes to completely elucidate the impact of this organ preservation technique.
ArticleNumber 100226
Author Altamirano, Francisco
Cordova, Mario A. O'Connor
Ortega-Macias, Alan G.
Gonzalez-Zorrilla, Fernando
Hoyos, Maria E.
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Keywords Liver transplant
Hypothermic hyperoxygenated perfusion
Static cold storage
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Snippet While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation. Following PRISMA...
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SubjectTerms Hypothermic hyperoxygenated perfusion
Liver transplant
Static cold storage
Title Outcomes of hypothermic hyperoxygenated perfusion compared to static cold storage for liver transplant. A systematic review and meta-analysis of randomized clinical trials
URI https://dx.doi.org/10.1016/j.liver.2024.100226
Volume 15
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