Matthias Pfister, Janina Eden, Hannah Rasel, Fariba Abbassi, Simon Störzer, Florin Botea, Bettina M Buchholz, Francisco C Novoa, Stefania Camagni, William C Chapman, Umberto Cillo, Arielle Cimeno, Philippe Compagnon, Miriam Cortes-Cerisuelo, Alexander R Cortez, Kris P Croome, Riccardo De Carlis, Dulce Diogo, Fabrizio Di Benedetto, Daniele Dondossola, John Fung, Jiri Fronek, Carlos Garcia, Georg Györi, Matthew Hamilton, Julie K Heimbach, Philipp Houben, Dionysios Koliogiannis, Chandrashekhar A Kubal, Hwai-Ding Lam, Tyler Lunow-Luke, Georg Lurje, Ajay Mahenthiran, Diethard Monbaliu, Hussein Nassar, Andreas Pascher, Madhukar S Patel, Damiano Patrono, Robert J Porte, Lukas Prommegger, Rithin Punjala, Matteo Ravaioli, Michel Rayar, John P Roberts, Garrett R Roll, Sangeeta Satish, Andrea Schlegel, Moritz Schmelzle, Stefan Schneeberger, Markus Selzner, James Shapiro, Gustaf Sörensen, Neeta Vachharajani, Parsia Vagefi, W Kenneth Washburn, Antonio Pinna, Philipp Dutkowski, Vincent E de Meijer, Pierre-Alain Clavien, Real-World Liver Perfusion Consortium
Real-world data on HOPE-treated and NMP-treated LT demonstrate excellent outcomes. Nevertheless, compared with HOPE, further high-quality evidence and longer preservation time is needed to substantiate the clinical benefits of NMP in high-risk grafts.
OBJECTIVE: To report real-world data on hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP) in liver transplantation (LT).
SUMMARY BACKGROUND DATA: Real-world comparisons between HOPE and NMP are limited and methodologically challenging due to heterogeneity in donor and recipient risk profiles and regional differences in practice patterns.
METHODS: This international cohort study analyzed consecutive NMP-preserved LTs performed at 15 predominantly North American centers between 2021 and 2025. Outcomes were compared with the European HOPE-REAL cohort, comprising HOPE-treated LTs from 22 centers between 2012 and 2021. Risk-adjusted analyses were performed, stratified by graft type and risk category. Imbalances in baseline characteristics were addressed using entropy balancing.
RESULTS: A total of 954 NMP-treated and 1202 HOPE-treated grafts were analyzed, revealing substantial differences in donor risk. Extended-criteria DBD grafts accounted for 30% versus 64%, and futile DCD grafts for 10% versus 30%, in the NMP and HOPE cohorts, respectively. In the NMP cohort, death-censored graft survival at 1, 2, and 3 years exceeded 96% for DBD grafts and 94% for DCD grafts. Comparable outcomes were observed in the HOPE cohort, with 93% survival in DBD and 87% in DCD grafts at up to 3 years, despite significantly higher donor risk in the HOPE-DCD cohort. After risk adjustment, death-censored graft survival remained similar between both modalities across graft types and risk categories.
CONCLUSIONS: Real-world data on HOPE-treated and NMP-treated LT demonstrate excellent outcomes. Nevertheless, compared with HOPE, further high-quality evidence and longer preservation time is needed to substantiate the clinical benefits of NMP in high-risk grafts.