Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta‐ Analysis of…

Abstract

Background : Hypothermic oxygenated machine perfusion (HOPE) is an alternative to static cold storage (SCS) for liver graft preservation, aiming to reduce ischemia–reperfusion injury (IRI) and improve post‐transplant outcomes. Methods : We systematically reviewed randomized controlled trials (RCTs) comparing HOPE with SCS in adult liver transplantation (MEDLINE, EMBASE, CENTRAL to July 2026). Outcomes included early allograft dysfunction (EAD), primary non‐function (PNF), major postoperative complications, biliary complications, including non‐anastomotic strictures (NAS), graft survival, and retransplantation. Results : Eight RCTs (984 patients; HOPE 461; SCS 523) met inclusion criteria. HOPE significantly reduced EAD (17.8% vs. 33.5%; RR 0.54, 95% CI 0.43–0.68; p < 0.00001) and PNF (0.4% vs. 3.6%; RR 0.26, 95% CI 0.09–0.75; p = 0.01). HOPE was associated with fewer major complications (Clavien–Dindo ≥ III) (41.2% vs. 50.7%; RR 0.80, 95% CI 0.70–0.93; p = 0.003), lower overall biliary complications (18.9% vs. 27.7%; RR 0.72, 95% CI 0.58–0.90; p = 0.004) and reduced NAS (3.3% vs. 7.6%; RR 0.43, 95% CI 0.23–0.82; p = 0.01). One‐year graft survival was comparable, while retransplantation was reduced after HOPE (RR 0.35, 95% CI 0.14–0.84, p = 0.02). Conclusion : HOPE improves early graft outcomes and reduces biliary morbidity and retransplantation compared with SCS, supporting its use to mitigate IRI.

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BibTeX RIS

BibTeX

@article{ellouze2026hypothermic,
  title = {{Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta‐ Analysis of Randomized Trials}},
  author = {Ameni Ellouze and Stylianos Tzedakis and Mohamad Ali Zorkot and Xavier Giudicelli and Karim Boudjema and Heithem Jeddou},
  journal = {Clinical Transplantation},
  year = {2026},
  month = sep,
  doi = {10.1111/ctr.70676},
  url = {https://ehesp.hal.science/hal-05752016v1},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta‐ Analysis of Randomized Trials
AU  - Ameni Ellouze
AU  - Stylianos Tzedakis
AU  - Mohamad Ali Zorkot
AU  - Xavier Giudicelli
AU  - Karim Boudjema
AU  - Heithem Jeddou
PY  - 2026
DA  - 2026/09/10
JO  - Clinical Transplantation
DO  - 10.1111/ctr.70676
UR  - https://ehesp.hal.science/hal-05752016v1
AB  - Background : Hypothermic oxygenated machine perfusion (HOPE) is an alternative to static cold storage (SCS) for liver graft preservation, aiming to reduce ischemia–reperfusion injury (IRI) and improve post‐transplant outcomes. Methods : We systematically reviewed randomized controlled trials (RCTs) comparing HOPE with SCS in adult liver transplantation (MEDLINE, EMBASE, CENTRAL to July 2026). Outcomes included early allograft dysfunction (EAD), primary non‐function (PNF), major postoperative complications, biliary complications, including non‐anastomotic strictures (NAS), graft survival, and retransplantation. Results : Eight RCTs (984 patients; HOPE 461; SCS 523) met inclusion criteria. HOPE significantly reduced EAD (17.8% vs. 33.5%; RR 0.54, 95% CI 0.43–0.68; p < 0.00001) and PNF (0.4% vs. 3.6%; RR 0.26, 95% CI 0.09–0.75; p = 0.01). HOPE was associated with fewer major complications (Clavien–Dindo ≥ III) (41.2% vs. 50.7%; RR 0.80, 95% CI 0.70–0.93; p = 0.003), lower overall biliary complications (18.9% vs. 27.7%; RR 0.72, 95% CI 0.58–0.90; p = 0.004) and reduced NAS (3.3% vs. 7.6%; RR 0.43, 95% CI 0.23–0.82; p = 0.01). One‐year graft survival was comparable, while retransplantation was reduced after HOPE (RR 0.35, 95% CI 0.14–0.84, p = 0.02). Conclusion : HOPE improves early graft outcomes and reduces biliary morbidity and retransplantation compared with SCS, supporting its use to mitigate IRI.
SN  - 0902-0063
SN  - 1399-0012
ER  -

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