Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2026.025

Dual hypothermic machine perfusion mitigates early allograft injury of liver grafts regardless of prolonged total preservation times - a retrospective study with propensity score matching analysis

Miroslav Kolarik1, 2, Martin Oliverius3, Petr Fila1, 2, Jiri Nicovsky1, 2, David Nespor1, 2, Vita Zampachova4, Aneta Zackova1, Monika Skotakova5, Petr Nemec1, 2
1 Center of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
2 Clinic of Cardiovascular Surgery and Transplantation, Masaryk University, Brno, Czech Republic
3 Clinic of Surgery, Third Faculty of Medicine, Charles University in Prague and Royal Vinohrady Teaching Hospital Prague, Prague, Czech Republic
4 First Department of Pathological Anatomy, St. Anne's University Hospital in Brno and Masaryk University, Brno, Czech Republic
5 Biostatistics Department, St. Anne's Faculty Hospital, Brno, Czech Republic

Aims: Transplant centers worldwide face the need to extend the donor acceptance criteria. To preserve the safety of transplantation, we have implemented a dual hypothermic oxygenated machine perfusion (DHOPE) program. This, in some cases, enabled a prolonged total preservation time (TPT), raising worries about the impact on graft outcomes. This study aimed to compare outcomes between DHOPE-treated grafts and conventionally stored grafts.

Methods: We analyzed outcomes of 21 DHOPE-preserved grafts and performed a propensity score-matched comparison with static cold storage (SCS) grafts. In addition, biopsies from 20 liver grafts were examined for histological evidence of preservation-related injury. All patients were followed for 1 year to assess graft and patient survival.

Results: The median TPT was significantly longer in the DHOPE group (10 hours 18 minutes) compared with the SCS group (5 hours 52 minutes; P<0.001). Despite this difference, no significant variation was observed between groups in terms of patient and graft survival, primary nonfunction, early allograft dysfunction, or major complications. Histological evaluation also showed no statistically significant differences in ischemia-reperfusion injury.

Conclusion: Our findings demonstrate that extending TPT during DHOPE is feasible and does not compromise safety. Both early postoperative outcomes and 1-year graft survival show no significant difference from conventional preservation.

Keywords: liver transplantation, hypothermic machine perfusion, ischemia-reperfusion injury, liver biopsy, prolonged cold ischemia time, DHOPE

Received: February 21, 2026; Revised: June 1, 2026; Accepted: August 12, 2026; Prepublished online: September 7, 2026 

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