December 2, 2013

HOPE for Human Liver Grafts obtained from Donors after Cardiac Death

Journal of Hepatology

Article in Press

P. Dutkowski, A. Schlegel, M. de Oliveira, B. Müllhaupt, P.-A. Clavien

Received 15 July 2013; received in revised form 22 November 2013; accepted 23 November 2013. published online 02 December 2013.
Accepted Manuscript



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.


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 minutes, followed by a standard cold flush and static storage at 4°C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2 h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10°C and oxygenated (pO2 60kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3mmHg.


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.


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.

Abbreviations: DCD, donation after cardiac death, DBD, Donation after brain death, HOPE, Hypothermic oxygenated perfusion, ICU,Intensive care unit, HCC, Hepatocellular Carcinoma, IC, Ischemic Cholangiopathy, MELD, Model for end stage liver disease, DAMPs, Danger associated molecular proteins

Keywords: DCD liver, Hypothermic oxygenated perfusion, Liver transplantation

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