Daytime Liver Transplants Safe After Prolonged Machine Perfusion: JAMA

Until now, liver transplantation has traditionally been an around the clock surgery procedure, where surgical teams had to perform operations in night shifts, due to which the fatigue among surgeons and disutility among patients was quite high. Recently, an observational study performed at a renowned university hospital in the Netherlands showed that performing DHOPE-PRO on a routine basis results in an immense number of liver transplants being done in the day shift with optimized surgical logistics.

The study was conducted from January 1, 2021, to December 31, 2024, using 330 liver transplantations on both adults and children. The researchers studied 175 transplants that occurred from the years 2023–2024 (after the regular use of DHOPE-PRO) as opposed to the control group of 155 transplants conducted in 2021–2022. The average age of participants was 45 years, and 186 of them (56.4%) were male. Grafts used in the study were acquired through DBD, DCD, and living donor methods. The criterion of effectiveness for this study was the number of "daytime" operations; these were procedures that started at or after 8 am and involved reperfusion at 8 pm or before.

Key findings:

• First, the percentage of daytime transplants according to reperfusion time improved from 48.4% (75 of 155) in the control group to 84.6% (148 of 175) in the DHOPE-PRO group (P<0.001).

• Daytime transplants, according to completion time, saw percentages improve from 53.5% (83 of 155) to 89.1% (156 of 175) (P<0.001).

• Median time of machine perfusion improved significantly from 2.1 to 10.2 hours (P<0.001).

• Most notably, total preservation time was safely prolonged to 31.4 hours in the study, creating a broad time span for planning purposes not available with conventional cold storage or short-time perfusions.

• DHOPE-PRO utilization had no significant relation to higher postoperative complications; for instance, the chance of developing new-onset acute kidney injury demonstrated an odds ratio of 0.64 (95% CI, 0.37-1.07; P = 0.09).

• One-year patient survival was surprisingly good, surpassing 90% in each subgroup of the study participants.

• According to the data obtained through statistical evaluation, there was no link between DHOPE-PRO and reduced survival of grafts (hazard ratio, 1.28 [95% CI, 0.59-2.74]; P=0.53) or patient survival (hazard ratio, 2.05 [95% CI, 0.75-5.59]; P = 0.16).

This prospective study demonstrates strong evidence of DHOPE-PRO as a revolutionary instrument in current liver transplantation surgery. It is achieved through maximizing the number of daytime procedures up to 90% from the existing 50%. Above all, the study has demonstrated that prolonged preservation does not have an effect on the high level of survival rate, which remains above 90%.

Reference:

Bodewes SB, Woltjes LC, Thorne AM, et al. Prolonged Dual Hypothermic Oxygenated Machine Perfusion for Daytime Liver Transplant. JAMA Netw Open. 2026;9(4):e265039. doi:10.1001/jamanetworkopen.2026.5039