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ROLE OF HYPOTHERMIC OXYGENATED MACHINE PERFUSION (HOPE) IN LIVER TRANSPLANTATION – AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED STUDIES
Sushrut Ingawale
*1, Marko Kozyk
3, A Mi Mi Kyaw
4, Suprabhat Giri
2, Dibya L. Praharaj
21Internal Medicine, Quinnipiac University - Frank H. Netter MD School of Medicine / St. Vincent's Medical Center, Bridgeport, CT; 2Kalinga Institute of Medical Sciences, Bhubaneswar, Orissa, India; 3Corewell Health Beaumont Hospital, Royal Oak, MI; 4Paramishin Hospital, Pyay, Myanmar
IntroductionMachine perfusion is increasingly being tested in clinical transplantation to increase the utilization of livers from marginal or extended-criteria donors. Hypothermic oxygenated perfusion (HOPE) is an
ex-situ liver perfusion approach that uses a highly oxygenated (pO2: >60 kPa) artificial solution at hypothermic temperatures (8-12 degrees celsius). The present meta-analysis aims to systematically review and analyze the protective effects of HOPE in liver transplantation (LT).
MethodsA comprehensive search of literature from inception to September 2024 was done of Medline, Scopus, and Embase for randomized controlled trials (RCT) comparing the outcome of HOPE and static cold storage (SCS) for LT. Risk ratios (OR) with 95% confidence intervals were calculated for all the dichotomous outcomes.
ResultsA total of 6 RCTs (n = 722) were included in the final analysis.
[Figure 1] The risks of both primary non-function and early allograft dysfunction were lower with HOPE with RR 0.28 (95% CI: 0.09-0.89,
I2 = 0%) and 0.52 (95% CI: 0.40-0.68,
I2 = 5%), respectively. The risk of major complications (Clavien Grade ?IIIb) and biliary complications were lower with HOPE with RR 0.76 (95% CI: 0.62-0.91,
I2 = 0%) and 0.71 (95% CI: 0.56-0.91,
I2 = 0%), respectively. However, among the biliary complications, the risk of non-anastomotic strictures was lower with HOPE with RR 0.35 (95% CI: 0.17-0.71,
I2 = 0%) but not anastomotic strictures RR 0.78 (95% CI: 0.56-1.09,
I2 = 0%). There was no difference in the risk of vascular complications between both groups with RR 0.56 (95% CI: 0.25-1.24,
I2 = 0%). On follow-up, the risks of graft loss and re-transplantation within 1 year were lower with HOPE with RR 0.37 (95% CI: 0.19-0.74,
I2 = 0%) and 0.21 (95% CI: 0.07-0.65,
I2 = 0%). The grade of evidence for various outcomes varied from moderate to high.
ConclusionThe present meta-analysis showed that HOPE significantly reduced the risk of primary non-function and early allograft dysfunction after LT while reducing the risk of overall and biliary complications. The risk of graft loss and re transplantation within 1 year was also lower with HOPE suggesting the advantage of HOPE over SCS in improving the peritransplant and medium-term outcomes.
Figure 1: Forest plot for the studies involved in the analysis.
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