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Hypothermic Machine Perfusion in Liver Transplantation — A Randomized Trial

Open access
van Rijn, Rianne, Schurink, Ivo J., de Vries, Yvonne, van den Berg, Aad P., Cortes Cerisuelo, Miriam, Darwish Murad, Sarwa, Erdmann, Joris I., Gilbo, Nicholas, de Haas, Robbert J., Heaton, Nigel, van Hoek, Bart, Huurman, Volkert A.L., Jochmans, Ina, van Leeuwen, Otto B., de Meijer, Vincent E., Monbaliu, Diethard, Polak, Wojciech G., Slangen, Jules J.G., Troisi, Roberto I., Vanlander, Aude, de Jonge, Jeroen, Porte, Robert J.·2021·New England Journal of Medicine

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. (Funded by Fonds NutsOhra; DHOPE-DCD ClinicalTrials.gov number, NCT02584283.).

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Metadata

Authors
van Rijn, R., Schurink, I. J., de Vries, Y., van den Berg, A. P., Cortes Cerisuelo, M., Darwish Murad, S., Erdmann, J. I., Gilbo, N., de Haas, R. J., Heaton, N., van Hoek, B., Huurman, V. A. L., Jochmans, I., van Leeuwen, O. B., de Meijer, V. E., Monbaliu, D., Polak, W. G., Slangen, J. J. G., Troisi, R. I., Vanlander, A., de Jonge, J., & Porte, R. J.
Venue
New England Journal of Medicine
Published
2021-04-15
Volume
384
Issue
15
Pages
1391-1401
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W3129886283
Cited by
649
References
23
FWCI
88.12
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Hypothermic Machine Perfusion in Liver Transplantation — A Randomized Trial. https://app.cochat.ai/papers/10.1056/nejmoa2031532
The paper
van Rijn, R., Schurink, I. J., de Vries, Y., van den Berg, A. P., Cortes Cerisuelo, M., Darwish Murad, S., Erdmann, J. I., Gilbo, N., de Haas, R. J., Heaton, N., van Hoek, B., Huurman, V. A. L., Jochmans, I., van Leeuwen, O. B., de Meijer, V. E., Monbaliu, D., Polak, W. G., Slangen, J. J. G., Troisi, R. I., . . . Porte, R. J. (2021). Hypothermic Machine Perfusion in Liver Transplantation — A Randomized Trial. New England Journal of Medicine. https://doi.org/10.1056/nejmoa2031532

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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