Hypothermic oxygenated perfusion(HOPE) improves ECD liver graft function and reduces duration of hospitalisation without extra cost: The PERPHO Study.

Few studies have evaluated the efficacy or the cost of Hypothermic Oxygenated PErfusion(HOPE) in the conservation of extended criteria donor (ECD) grafts from brain-dead donors (DBD) during liver transplantation(LT). The PERPHO Study (NCT03376074) is a prospective, monocentric, study designed to evaluate the interest of HOPE for ECD-DBD grafts. For comparison, a control group was selected after propensity score matching among patients transplanted between 2010 and 2017. Between February and November2018, the HOPE procedure was used in 25 LT. Immediately after LT, the median AST level was significantly lower in the HOPE-group (724vs 1284, p=0.046), as was ALT (392vs 720, p=0.01), lactate (2.2vs 2.7, p=0.01) and creatinine levels (73vs 89, p=0.01). There was a significant reduction in ICU stay (3vs 5days, p=0.01) and hospitalization (15vs 20days, p=0.01) in the HOPE-group. There was no significant difference regarding the incidence of early allograft dysfunction (EAD) (28% vs 42%, p=0.22) or PNF (8% vs 3%, p=0.29) between the HOPE and control-groups. A level of AST or ALT in perfusate> 800 was found to be highly predictive of EAD occurrence (AUC 0.92 and 0.91, respectively). The 12-month graft (88% vs 89.5%, p=1) and patient survival (91% vs 91.3%, p=1) were similar. The additional cost of HOPE was estimated at €5298 per patient. The difference between costs and revenues, from the hospital’s perspective, was not different between the HOPE and control groups (respectively +€3023 vs +€4059, IC[-€5470; +€8652]). In conclusion, HOPE may improveECD graft function and reduced hospitalization stay without extra cost. These results must be confirmed in a randomized trial.