Decreased Rejection Severity with Hypothermic Oxygenated Perfusion: Sub Analysis from a Pivotal Multicenter Trial of HOPE for Liver Transplantation
Recommended Citation
Reich DJ, Schlegel A, Mao S, Hashimoto K, Nassar A, Rizzari M, Foley D, Florman S, Arvelakis A, de Vera M, Pinna A, Bohorquez H, Roll G, Mihaylov P, Kubal C, Saharia A, Akoad M, Melcher M, Merani S. Decreased Rejection Severity with Hypothermic Oxygenated Perfusion: Sub Analysis from a Pivotal Multicenter Trial of HOPE for Liver Transplantation. Am J Transplant 2025; 25(8):S238-S239.
Document Type
Conference Proceeding
Publication Date
8-1-2025
Publication Title
Am J Transplant
Abstract
Purpose: Hypothermic oxygenated perfusion (HOPE) mitigates ischemia reperfusion injury and downstream immune mediated complications in liver transplant (LT) recipients. We analyzed allograft rejection outcomes in the US multicenter Bridge to HOPE RCT comparing static cold storage (SCS) alone with SCS followed by end ischemic HOPE for increased risk DBD and DCD LTs. The trial, completed in 11/2024, demonstrated significant reduction in Early Allograft Dysfunction in the HOPE arm (primary endpoint superiority, p=.005) and other improved outcomes, including shorter hospital stays, reduced severity of cholangiopathy, and fewer graft failures. The rejection outcomes haven't previously been reported. Methods: The trial has been described (clinicaltrials.gov: Nct05045794). We analyzed data from the full cohort of 219 patients; each had 1-yr follow-up except 7 that died (3 HOPE, 4 SCS). Biopsy proven rejection (BPR) was graded by Banff Classification and assessed for treatment with steroids and anti-thymocyte globulin (ATG). Results: Baseline demographics and immunosuppression were similar between arms (Table); autoimmune liver disease trended higher in SCS. Rejection prevalences were comparable between arms (HOPE: 25 pts [23%], 27 events; SCS: 26 pts [24%], 28 events). Seven of 51 patients with presumed rejection lacked biopsy confirmation (2 HOPE, 5 SCS); there were 44 BPRs, also with similar prevalences between arms (Table). Mycophenolate use at the time of BPR was more common in SCS. Moderate/severe BPR was less common in HOPE than SCS (32% v 67%, p=.033; Figure). Ten patients developed steroid resistant BPR (SRR) requiring ATG, 1 in HOPE and 9 in SCS (4% v 43%, p=.003; Figure); 1 of the 9 SCS patients failed ATG and underwent urgent re-LT on day 13 for accelerated BPR and another 3/9 SCS patients had unresolved SRR at the end of study follow-up. Conclusions: While the prevalence of BPR was similar in HOPE and SCS, HOPE was associated with significantly less severe BPR and a significantly lower risk of SRR. These results highlight the immunomodulatory benefits of HOPE and warrant further research. [Formula presented] CITATION INFORMATION: Reich D., Schlegel A., Mao S., Hashimoto K., Nassar A., Rizzari M., Foley D., Florman S., Arvelakis A., de Vera M., Pinna A., Bohorquez H., Roll G., Mihaylov P., Kubal C., Saharia A., Akoad M., Melcher M., Merani S. Decreased Rejection Severity with Hypothermic Oxygenated Perfusion: Sub Analysis from a Pivotal Multicenter Trial of HOPE for Liver Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: D.J. Reich: None.
Volume
25
Issue
8
First Page
S238
Last Page
S239
