Economic Assessment of Hypothermic Oxygenated Machine Perfusion in Liver Transplantation
Recommended Citation
Axelrod D, Reich D, Schlegel A, Mao S, Hashimoto K, Nassar A, Foley D, Florman S, Arvelakis A, de Vera M, Pinna A, Bohorquez H, Roll G, Kubal S, Saharia A, Akoad M, Melcher M, Merani S, Mihaylov P, Schnitzler M. Economic Assessment of Hypothermic Oxygenated Machine Perfusion in Liver Transplantation. Am J Transplant 2025; 25(8):S185.
Document Type
Conference Proceeding
Publication Date
8-1-2025
Publication Title
Am J Transplant
Abstract
Purpose: Liver transplantation (LT) has been fundamentally changed by the development of novel machine preservation (MP) technology, although widespread adoption has been limited by financial considerations. Back-to-base hypothermic oxygenated perfusion (HOPE) is a potential solution, as it improves outcomes following LT using both donors after brain death (DBD) and circulatory death (DCD) but requires fewer resources than other MP technologies. This study aimed to assess the financial benefits of HOPE using results from a contemporary randomized controlled trial. Methods: We examined the financial implications of key post-LT outcomes reported in the Bridge to Life clinical trial comparing HOPE following ex vivo liver preservation with static cold storage (SCS) to SCS alone (clinicaltrials.gov: Nct05045794). Financial analyses were assessed using a Markov model. The cost of key events (LT, re-transplant (re-LT), death, and biliary complications [BC]) requiring invasive intervention were estimated from Medicare payment data. National hospital cost accounting data were used to assess cost per hospital day. Credible Interval (CrI) was determined using robust sensitivity analysis. Results: Compared to SCS only (N=110), LT using HOPE (N=109) reduced initial post-LT hospital length of stay (10.8 vs. 12.9 days), BCs (20.2% vs. 24.6%), re-LT(1.8% vs. 4.5%), and death (2.8% vs. 3.6%). HOPE reduced 1 year cost of LT by $28,565 (CrI: 23,027-$34,541). Savings was greater for DCD LT ($64,370: CrI $52,507 to $78,761) than DBD organs ($16,929: CrI $13,203 to $19,805).. Conclusions: HOPE for a minimum 1.5 hours at the recipient hospital reduced the cost of LT by shortening the index hospitalization and decreasing late complications (BCs, graft failure and death). Additional financial benefits may include increased organ utilization, reduced staff overtime, and fewer high MELD transplants. [Formula presented] CITATION INFORMATION: Axelrod D., Reich D., Schlegel A., Mao S., Hashimoto K., Nassar A., Foley D., Florman S., Arvelakis A., de Vera M., Pinna A., Bohorquez H., Roll G., Kubal S., Saharia A., Akoad M., Melcher M., Merani S., Mihaylov P., Schnitzler M. Economic Assessment of Hypothermic Oxygenated Machine Perfusion in Liver Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: D. Axelrod: Consultant; Bridge to Life, CareDx. Scientific/Medical Advisory Board Member; Specialist Direct. Consultant; BMI Organ Bank.
Volume
25
Issue
8
First Page
S185
