Pereyra David, Dingfelder Jule, Riha Moriz, Kacar Sertac, Rauter Laurin, Becker Nikolaus, Saffarian Zadeh Tina, Tortopis Chiara, Starlinger Patrick, Ristl Robin, Silberhumer Gerd, Salat Andreas, Soliman Thomas, Berlakovich Gabriela, Gyoeri Georg
Department of General Surgery, Division of Transplantation, Medical University of Vienna, General Hospital of Vienna.
Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria.
Int J Surg. 2024 Dec 1;110(12):7909-7918. doi: 10.1097/JS9.0000000000002115.
Corroborating evidence for the use of hypothermic oxygenated machine perfusion (HOPE) prior to orthotopic liver transplantation (OLT) suggests a beneficial effect in regard to biliary complications. Here, the authors aim to evaluate whether perfusion via portal vein alone (sHOPE) or via additional perfusion of the hepatic artery (dHOPE) have diverging impact on outcomes after OLT when compared to the use of static cold storage (SCS).
Consecutive patients undergoing OLT at the Medical University of Vienna (2018-2023) were retrospectively analyzed. Donor organs were procured using SCS, or subjected to end-ischemic sHOPE or dHOPE. The severity of biliary complications was classified according to the degree of therapeutic intervention (endoscopic retrograde cholangiopancreatography or surgical revision).
Two hundred forty-seven patients were included (69 SCS, 76 sHOPE, and 102 dHOPE). Hospitalization was shorter for patients after HOPE (median in days: SCS=25 vs HOPE=20, P =0.019). Biliary complications were less frequent in patients after HOPE (SCS=37.7% vs HOPE=22.5%, P =0.015). A significantly lower incidence of surgical revisions for biliary complications was observed in the HOPE cohort (24.6% vs 11.8%, P =0.012). When evaluating outcome according to HOPE-modality, a significant reduction in biliary complications ( P =0.006) and surgical revisions ( P =0.002) was only observed in dHOPE patients in comparison to SCS. Further, only dHOPE was significantly associated with a reduced need for surgical revision for biliary complications upon univariable and multivariable logistic regression (odds ratio=0.336, P =0.011).
HOPE leads to a reduction of biliary complications and associated surgical revisions. This effect seems to be primarily associated with use of dHOPE, while both methods appear as feasible options for preconditioning of donor grafts prior to OLT.
原位肝移植（OLT）前使用低温氧合机器灌注（HOPE）的确证证据表明其在胆道并发症方面具有有益作用。在此，作者旨在评估与静态冷藏（SCS）相比，单纯经门静脉灌注（sHOPE）或经肝动脉额外灌注（dHOPE）对OLT术后结局是否有不同影响。
对维也纳医科大学（2018 - 2023年）接受OLT的连续患者进行回顾性分析。供体器官采用SCS获取，或进行缺血末期sHOPE或dHOPE处理。根据治疗干预程度（内镜逆行胰胆管造影或手术翻修）对胆道并发症的严重程度进行分类。
纳入247例患者（69例SCS，76例sHOPE，102例dHOPE）。HOPE术后患者的住院时间较短（中位数天数：SCS = 25天 vs HOPE = 20天，P = 0.019）。HOPE术后患者的胆道并发症发生率较低（SCS = 37.7% vs HOPE = 22.5%，P = 0.015）。在HOPE队列中，观察到因胆道并发症进行手术翻修的发生率显著降低（24.6% vs 11.8%，P = 0.012）。当根据HOPE模式评估结局时，与SCS相比，仅在dHOPE患者中观察到胆道并发症（P = 0.006）和手术翻修（P = 0.002）显著减少。此外，在单变量和多变量逻辑回归分析中，只有dHOPE与减少因胆道并发症进行手术翻修的需求显著相关（比值比 = 0.336，P = 0.011）。
HOPE可减少胆道并发症及相关手术翻修。这种效果似乎主要与dHOPE的使用有关，而两种方法似乎都是OLT前供体移植物预处理的可行选择。
