Hypothermic-Oxygenated and Normothermic Machine Perfusion: A Risk-Matched Post-Hoc Comparison of the Bridge to Hope Randomized Trial with Prospectively Collected Institutional Outcomes
Recommended Citation
Wehrle CJ, Mao S, Satish S, Hashimoto K, Nassar A, Rizzari M, Foley D, Florman S, DeVera M, Pinna A, Reich D, Bohorquez H, Roll G, Mihaylov P, Kubal C, Saharia A, Akoad M, Melcher M, Merani S, Schlegel A. Hypothermic-Oxygenated and Normothermic Machine Perfusion: A Risk-Matched Post-Hoc Comparison of the Bridge to Hope Randomized Trial with Prospectively Collected Institutional Outcomes. Am J Transplant 2025; 25(8):S86.
Document Type
Conference Proceeding
Publication Date
8-1-2025
Publication Title
Am J Transplant
Abstract
Purpose: Hypothermic-Oxygenated (HOPE) and Normothermic Machine Perfusion (NMP) are the two most popular techniques for ex-situ liver perfusion. Despite routine use in many countries, their clinical outcomes have never been directly compared. Methods: This is a post-hoc comparison of the Bridge to Hope (BtH) RCT (Nct05045794; VitaSmart®) with prospectively collected institutional outcomes with NMP (OrganOx metra®). Both were applied after static cold storage (SCS) in the recipient center. Institutional and RCT SCS-only cases were compared to assess whether differences were attributable to preservation type or other practices. HOPE vs. NMP and SCS vs. SCS cases with 12m active follow-up were propensity-matched (PSM) using donor age, donor-risk index (DRI), cold ischemia time, graft type (DBD vs. DCD), recipient age, and labMELD. Standardized Core Outcome Sets (COS) were used for complication reporting. Results: Overall, 1,029 transplantations were included: 407 perfusion (HOPE=109; NMP=308) and 622 SCS (BtH=110, Institution=512). After risk-matching, all measured risk-factors and post-LT outcomes for SCS cases were similar. Following PSM, 101 pairs (DBD=77, DCD=24) demonstrated balancing of all measured risk factors. Median DRI was 1.98 [1.7-2.3] and 2.1 [1.74-2.3] for NMP and HOPE. HOPE-treated grafts demonstrated improved graft (log-rank p=0.042) and recipient survival (log-rank p=0.029), and major complications (Clavien Grade III-V) in hospital (p=0.003), at 3- (p=0.030) and 6-months (p=0.031). Cumulative complications measured by CCI were reduced with HOPE at 3m (34.6 [IQR=27-48] vs. 43.3 [28-57], p=0.031), 6m (38.7 [29-52] vs. 48.3 [35-71], p<0.001) and 12m (39.4 [30-53] vs. 53.6 [41-76], p<0.001). Finally, HOPE reduced non-anastomotic strictures (NAS, 4% vs. 11%, p=0.04) in all patients. Within the DCD sub-cohort (HOPE=24 vs. NMP=24), NAS (8% vs. 21%) and AS (10% vs. 29%) were reduced though not significant. NAS-associated graft loss was HOPE=4% (n=1) and NMP=13% (n=3). Conclusions: HOPE-treatment may improve outcomes further over what has already been seen with NMP in the US. CITATION INFORMATION: Wehrle C., Mao S., Satish S., Hashimoto K., Nassar A., Rizzari M., Foley D., Florman S., DeVera M., Pinna A., Reich D., Bohorquez H., Roll G., Mihaylov P., Kubal C., Saharia A., Akoad M., Melcher M., Merani S., Schlegel A. Hypothermic-Oxygenated and Normothermic Machine Perfusion: A Risk-Matched Post-Hoc Comparison of the Bridge to Hope Randomized Trial with Prospectively Collected Institutional Outcomes AJT, Volume 25, Issue 8 Supple- ment 1 DISCLOSURES: C.J. Wehrle: None.
Volume
25
Issue
8
First Page
S86
