- Design
- Mechanistic substudy of a three-arm randomised controlled trial
- Population
- 47 recipients of extended-criteria livers from brain-dead donors
- Primary outcome
- Hepatic and systemic immune responses after transplantation
- Effect
- Reduced neutrophil infiltration in early reperfusion injury with both perfusion methods
This mechanistic substudy of the HOPE-NMP randomised trial studied 47 recipients of extended-criteria livers from brain-dead donors, randomised to static cold storage, end-ischaemic hypothermic oxygenated perfusion or end-ischaemic normothermic perfusion. Biopsies and serial blood samples were analysed with flow cytometry, spatial immunofluorescence and cytokine profiling.
Both perfusion methods reduced neutrophil infiltration during early reperfusion injury and shifted graft myeloid cells away from a pro-inflammatory, adhesive state. After hypothermic oxygenated perfusion, circulating NK and T cells recovered faster and systemic neutrophil counts were lower, which correlated with less liver injury.
Machine perfusion already improves clinical outcomes in trials; this work suggests why. It is a small laboratory substudy and makes no claim on graft or patient survival by itself, but it supports wider use of perfusion for marginal donor livers.
- Machine perfusion is increasingly used to make extended-criteria donor livers usable.
- Both hypothermic oxygenated and normothermic perfusion reduced early neutrophil-driven graft inflammation.
- Hypothermic oxygenated perfusion was linked to faster recovery of circulating immune cells.
- These mechanistic findings do not by themselves establish which perfusion method gives better survival.
Why it matters
It gives a biological basis for the clinical advantages of perfusing donor livers before implantation.
Don't overread it
This mechanistic substudy of 47 patients does not compare clinical outcomes between methods.
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