Reducing cold ischemia time by donor liver “back-table” preparation under continuous oxygenated machine perfusion of the portal vein

Abstract

Introduction: Cold ischemia time is a well-known risk factor for the development of non-anastomotic biliary strictures (NAS) after liver transplantation. End-ischemic hypothermic oxygenated machine perfusion (HOPE) of DCD liver grafts reduces the incidence of NAS, and has the potential to reduce cold ischemia times. We hypothesized that if a part of the back-table procedure could be performed under continuous HOPE, cold ischemia times would be reduced. Methods: In this prospective observational cohort study, all nationwide declined livers that underwent DHOPE-NMP between July 1st 2021 and January 1st 2022 were included. The back-table of ten consecutive high-risk donor livers was performed with ongoing HOPE. Sixty DHOPE-NMP procedures (August 1st 2017–July 1st 2021) with a conventional back-table procedure functioned as a control group. Results: Compared to the control group, this technique led to a decrease in non-oxygenated back-table time from median 74 min (IQR 58–92 min) to median 25 min (IQR 21–31 min), p