Long-term Follow-up After Hypothermic Oxygenated Machine Perfusion in DCD Liver Transplantation:Results of a Randomized Controlled Multicenter Trial (DHOPE-DCD)

BACKGROUND AND AIM: Transplantation of livers from donation after circulatory death (DCD) donors is associated with an increased risk of nonanastomotic biliary strictures (NAS). Dual hypothermic oxygenated machine perfusion (DHOPE) of donor livers before transplantation has been shown to reduce the incidence of symptomatic NAS and acute cellular rejection (ACR) within 6 months, but long-term results are unknown. The aim of this study was to assess the 5-year incidence of NAS and ACR in the DHOPE-DCD Trial (ClinicalTrials.gov number NCT02584283). METHODS: Between January 2016 and July 2019 recipients of DCD livers in 6 European centers were randomly assigned to receive that liver either after DHOPE (machine perfusion group) or after conventional static cold storage (control group). Primary endpoint was the incidence of NAS at 5-year follow-up. Secondary endpoints included ACR, graft, and patient survival. RESULTS: A total of 78 patients were included in the machine perfusion group and 78 patients in the control group. After 5 years of follow-up, the incidence of NAS was significantly lower in the machine perfusion group, compared with control group: 14% versus 26% (hazard ratio: 0.47, 95% CI: 0.23-0.99; P=0.048). In patients with immune-mediated disease, who are at increased risk of ACR, the rate of ACR was significantly lower in the machine perfusion group: 0% versus 32% (P=0.036). CONCLUSIONS: The short-term benefits of DHOPE in DCD liver transplantation persist up to 5-year post-transplant, with significant reductions in incidence of NAS, and ACR in high-risk patients, compared with conventional static cold storage.