Design: Systematic review and meta-analysis of 8 randomised trials
Population: 984 adult liver transplant recipients
Primary outcome: Early allograft dysfunction, primary non-function, complications, graft survival
Effect: EAD 17.8% vs 33.5%, RR 0.54 (95% CI 0.43–0.68); non-anastomotic strictures RR 0.43 (0.23–0.82); retransplantation RR 0.35 (0.14–0.84)

This meta-analysis pooled 8 randomised trials of 984 adult liver transplants comparing hypothermic oxygenated machine perfusion (HOPE) with static cold storage for graft preservation.

HOPE roughly halved early allograft dysfunction (17.8% vs 33.5%) and reduced primary non-function (0.4% vs 3.6%). Major complications, overall biliary complications and non-anastomotic strictures (3.3% vs 7.6%) were all less frequent, and retransplantation was reduced. One-year graft survival did not differ.

Machine perfusion has moved from experimental to evidence-based for improving early graft function and reducing biliary injury. For Indian liver transplant programmes, which rely heavily on living donors, the relevance is greatest for deceased donor and extended criteria grafts. Cost and device availability remain the practical limits.

Consider HOPE for deceased donor grafts, especially extended criteria organs
Track early allograft dysfunction and biliary strictures as programme quality measures
Weigh device cost against reduced complications and retransplantation
Note that one-year graft survival did not change

Why it matters

It confirms that how a liver graft is stored changes early outcomes and biliary complications.

The statistics, in plain English

RR 0.54 (95% CI 0.43–0.68) for early allograft dysfunction is a large, precise reduction. Primary non-function was rare, so its RR 0.26 (0.09–0.75) rests on few events. No difference in one-year graft survival means early benefits have not yet translated into longer graft life.