184 Experience of Hypothermic Oxygenated Machine Perfusion for Liver Transplantation and Ex-vivo Liver Resection-largest reported single centre experience in the UK

Abstract Background Hypothermic oxygenated machine perfusion (HOPE) is being increasingly utilised in deceased donor liver transplantation to recondition expanded-criteria livers prior to transplantation as well as reducing night time liver transplants. In the UK experience of HOPE for liver transplantation is limited. This is the UK’s largest reported series in addition to experience with ex vivo liver resection and auto transplantation Methods Retrospective case note review of consecutive patients who underwent HOPE from 2016-2024. Hypothermic Perfusion was either single (PV) or dual (HA and PV). Results Fifty-two patients received HOPE-preserved liver grafts (first transplant n = 51), with a median age 61 (IQR 52-65); dual-HOPE was performed in 11 liver grafts. There were 3 mortalities (5.8%) in the series. There were 50 DCD liver grafts and 2 DBD liver grafts. Nineteen (36.5%) had clinically-significant portal hypertension, the median UKELD score was 52 (IQR 49-55). Significant post reperfusion syndrome occurred in 4 (7.7%) and early allograft dysfunction occurred in 6(11.5%). Three (5.8%) required re-transplantation for primary non-function (n = 1), hepatic artery thrombosis (n = 1), and liver infarction following embolisation of hepatic artery pseudoaneurysm (n = 1). A further patient underwent the world’s first HOPE ex vivo liver resection and auto-transplant for an large retro-hepatic IVC Leiomyosarcoma that was initially deemed unresectable, is alive and well at 6 months follow up. Conclusion HOPE is a useful tool to improve utilisation rates of more marginal, expanded criteria donor livers as well as potentially improving the resectability rates of complex liver tumours.