title: HOPE for human liver grafts obtained from donors after cardiac death.
abstract: OBJECTIVE
  Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs.
  
  
  METHODS
  Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38 min, followed by a standard cold flush and static storage at 4 °C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10 °C and oxygenated (pO2 60 kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3 mmHg.
  
  
  RESULTS
  Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5 months.
  
  
  CONCLUSIONS
  This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.
authors.affiliation: Department of Surgery & Transplantation, University Hospital Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dutkowski
authors.affiliation: Department of Surgery & Transplantation, University Hospital Zurich, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schlegel
authors.affiliation: Department of Surgery & Transplantation, University Hospital Zurich, Switzerland.
authors.forename: Michelle
authors.initials: M
authors.lastname: de Oliveira
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Department of Surgery & Transplantation, University Hospital Zurich, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Neff
authors.affiliation: Department of Surgery & Transplantation, University Hospital Zurich, Switzerland. Electronic address: clavien@access.uzh.ch.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D003080:Cold Temperature; D003643:Death; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D019188:Organ Preservation Solutions; D010100:Oxygen; D010477:Perfusion / Q000295:instrumentation / Q000379:methods; D011169:Portal Vein; D051381:Rats; D014019:Tissue Donors
chemical_list: D019188:Organ Preservation Solutions; D010100:Oxygen
keywords: DCD liver; Hypothermic oxygenated perfusion; Liver transplantation