Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant: What is the evidence?

Table 2 Clinical studies assessing the impact of hypothermic machine perfusion on ischemic type biliary lesions after liver transplantation

Ref.	Study design	Group (n)	DBD/DCD	HOPE duration (median)	Definition of ITBL	Follow up	ITBL-intervention		ITBL-control
							DCD	DBD	DCD	DBD
Schlegel et al[61], 2023	RCT	HOPE (85) vs SCS (85)	DBD	95.5 min	NR	12 mo	NA	1/85 (1.2%)	NA	3/85 (3.5%)
Ravaioli et al[56], 2022	RCT	HOPE (66) vs SCS (69)	DBD	145 min	Nonspecifically provided: Biliary strictures; Biliary others	12 mo	NA	5/55 (9%)	NA	6/55 (11%)
van Rijn et al[52], 2021	RCT	D-HOPE (78) vs SCS (78)	DCD	132 min	Symptomatic NAS diagnosed with the use of 6-mo cholangiography in the presence of a patent HA	6 mo	5/78 (6%)	NA	14/78 (18%)	NA
Czigany et al[57], 2021	RCT	HOPE (23) vs SCS (23)	DBD	145 min	Biliary complications (clinical; radiological)	12 mo	NA	4/23 (17%)	NA	6/23 (26%)
Patrono et al[60], 2022	Cohort	D-HOPE (121) vs SCS (723)	DBD	138 min	Biliary complications 3-mo cholangiography if clinically indicated	Median 21.6 (D-HOPE) and 51.1 (SCS) mo	NA	5/121 (4%)	NA	35/723 (5%)
Rayar et al[58], 2021	Cohort	HOPE (25) vs SCS (69)	DBD	117 min	NR	12 mo	NA	0/25 (0%)	NA	1/69 (1.5%)1
Muller et al[37], 2020	Cohort	NRP (132) vs HOPE (93)	DCD	132 min	NAS was defined as strictures with or without HA thrombosis or arterial complications.	Median 20 (NRP) 28 mo (HOPE) mo	2/32 (6.3%)	NA	4/32 (12.5%)	NA
Ravaioli et al[59], 2020	Cohort	HOPE (10) vs SCS (30)	DBD	132 min	NR	12 mo	NA	NP	NA	NP
Schlegel et al[55], 2019	Cohort	HOPE (50) vs SCS DBD (50) vs SCS DCD (50)	Both	120 min	Ischemic cholangiopathy defined radiologically, as intrahepatic or hilar BS and dilatations with patent HA	5 yr	4/50 (8%)	NA	11/50 (22%)	1/50 (2%)
van Rijn et al[51], 2017	Cohort	D-HOPE (10) vs SCS (20)	DCD	126 min	NAS was defined as bile duct stenosis in the biliary tree as detected by ERCP or MRCP with clinical signs of cholestasis and/or cholangitis in the presence of a patent HA	12 mo	1/10 (10%)	NA	9/20 (45%)2	NA

¹Ischemic necrosis.

²Biliary necrosis 2/9.

BS: Biliary strictures; DBD: Donor after Brain Death; DCD: Donated after circulatory death; ERCP: Endoscopic retrograde cholangiopancreatography; HA: Hepatic artery; ITBL: Ischemic type biliary lesions; MRCP: Magnetic resonance cholangiopancreatography; NAS: Nonanastamotic biliary strictures; NR: Not reported; NA: Not available.