title: Dual hypothermic oxygenated machine perfusion in liver transplants donated after circulatory death.
abstract: BACKGROUND
  Experimental studies have suggested that end-ischaemic dual hypothermic oxygenated machine perfusion (DHOPE) may restore hepatocellular energy status and reduce reperfusion injury in donation after circulatory death (DCD) liver grafts. The aim of this prospective case-control study was to assess the safety and feasibility of DHOPE in DCD liver transplantation.
  
  
  METHODS
  In consecutive DCD liver transplantations, liver grafts were treated with end-ischaemic DHOPE. Outcome was compared with that in a control group of DCD liver transplantations without DHOPE, matched for donor age, donor warm ischaemia time, and recipient Model for End-stage Liver Disease (MELD) score. All patients were followed for 1 year.
  
  
  RESULTS
  Ten transplantations involving liver grafts treated with DHOPE were compared with 20 control procedures. There were no technical problems. All 6-month and 1-year graft and patient survival rates were 100 per cent in the DHOPE group. Six-month graft survival and 1-year graft and patient survival rates in the control group were 80, 67 and 85 per cent respectively. During DHOPE, median (i.q.r.) hepatic adenosine 5'-triphosphate (ATP) content increased 11-fold, from 6 (3-10) to 66 (42-87) µmol per g protein (P = 0·005). All DHOPE-preserved livers showed excellent early function. At 1 week after transplantation peak serum alanine aminotransferase (ALT) and bilirubin levels were twofold lower in the DHOPE group than in the control group (ALT: median 966 versus 1858 units/l respectively, P = 0·006; bilirubin: median 1·0 (i.q.r. 0·7-1·4) versus 2·6 (0·9-5·1) mg/dl, P = 0·044). None of the ten DHOPE-preserved livers required retransplantation for non-anastomotic biliary stricture, compared with five of 20 in the control group (P = 0·140).
  
  
  CONCLUSIONS
  This clinical study of end-ischaemic DHOPE in DCD liver transplantation suggests that the technique restores hepatic ATP, reduces reperfusion injury, and is safe and feasible. RCTs with larger numbers of patients are warranted to assess the efficacy in reducing post-transplant biliary complications.
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Rijn
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Karimian
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: A P M
authors.initials: APM
authors.lastname: Matton
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: Burlage
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Westerkamp
authors.affiliation: Department of Gastroenterology and Hepatology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van den Berg
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: R H J
authors.initials: RHJ
authors.lastname: de Kleine
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: de Boer
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-3503-7140
authors.initials: T
authors.lastname: Lisman
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Porte
mesh_terms: D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
chemical_list: D010100:Oxygen