January 26, 2018
2 min read

Hypothermic oxygenated machine perfusion reduces bile duct injury after liver transplantation

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Dual hypothermic oxygenated machine perfusion, or DHOPE, reduced ischemia-reperfusion injury of bile ducts after transplantation with donation after circulatory death livers, according to a recently published study.

“The results of this study clearly demonstrated a reduction in biliary [ischemia-reperfusion (IR)] injury of DHOPE-preserved [donation after circulatory death (DCD)] livers, compared to DCD livers that did not undergo DHOPE,” Rianne van Rijn, PhD student from the University of Groningen, the Netherlands, and colleagues wrote. “These findings provide important new insight in the protective mechanism of end-ischemic DHOPE and are in line with the clinically observed reduction in the incidence of [non-anastomotic biliary strictures (NAS)] after DCD liver transplantation when DHOPE is applied.”

During a phase 1 study, Rijn and colleagues followed 10 patients who underwent DCD liver transplantation in which the livers were preserved with DHOPE for 2 hours after conventional static cold storage. Additionally, the researchers included 20 patients who underwent standard DCD liver transplantation as controls.

The donors in the DHOPE group had higher latest alanine aminotransferase levels (72 vs. 29 U/L; P = .008) and peak ALT (121 vs. 33 U/L; P < .001), shorter cold ischemia time (358 vs. 426 minutes; P = .002) and longer preservation time (521 vs. 430 minutes; P = .002) compared with the donors in the control group.

Patients in the control group had more severe histological bile duct damage after reperfusion compared with baseline, especially regarding mural stroma necrosis (P = .002) and deep peribiliary glands (PBG; P = .02). Patients in the DHOPE group, however, had no significant increase in the severity of histological biliary injury after reperfusion and had significantly less injury and loss of cells in the periluminal (P = .04) and deep PBG (P = .04) compared with controls.

Within 1 year after transplantation, 10% of the DHOPE group and 35% of the control group presented NAS. The difference was not significant.

While none of the patients in the DHOPE group required retransplantation for NAS, four patients in the control group needed retransplantation at a median of 9 months (range, 6-12 months) after transplantation for NAS.

“The DHOPE-preserved livers in the present study demonstrated significantly less severe injury of the deep and periluminal PBG after reperfusion, compared to the control livers that did not undergo DHOPE,” the researchers wrote. “The protective effect of DHOPE on PBG may lead to better preserved regenerative biliary capacity followed by a reduction of the incidence of NAS.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.