Hypothermic Machine Perfusion in Liver Transplantation - A Randomized Trial

DHOPE-DCD Trial Investigators, Rianne van Rijn, Ivo J Schurink, Yvonne de Vries, Aad P van den Berg, Miriam Cortes Cerisuelo, Sarwa Darwish Murad, Joris I Erdmann, Nicholas Gilbo, Robbert J de Haas, Nigel Heaton, Bart van Hoek, Volkert A L Huurman, Ina Jochmans, Otto B van Leeuwen, Vincent E de Meijer, Diethard Monbaliu, Wojciech G Polak, Jules J G Slangen, Roberto I TroisiAude Vanlander, Jeroen de Jonge, Robert J Porte*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



Transplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.


In this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.


A total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.


Hypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage.

Original languageEnglish
Pages (from-to)1391-1401
Number of pages11
JournalNew England Journal of Medicine
Issue number15
Early online date24-Feb-2021
Publication statusPublished - 15-Apr-2021

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