Portal-Venous Hypothermic Oxygenated Perfusion in Liver Transplantation: Evidence Synthesis from the Bridge to HOPE Trial and Global Clinical Landscape

Highlights

• The Bridge to HOPE trial (NCT05045794) established the superiority of end-ischemic portal-venous HOPE over static cold storage (SCS), reducing early allograft dysfunction (EAD) from 37.3% to 20.2%.
• HOPE treatment leads to shorter hospital lengths of stay and improved metabolic function scores (MEAF) in recipients of extended criteria donor (ECD) grafts.
• Beyond early function, HOPE improves biliary lipid secretion and reduces bile acid toxicity, potentially mitigating long-term nonanastomotic biliary strictures (NAS).
• Emerging evidence suggests that HOPE possesses immunomodulatory properties, increasing donor-specific regulatory T cells and potentially reducing hepatocellular carcinoma (HCC) recurrence.

Background