P-4 HYPOTHERMIC OXYGENATED PERFUSION USING AN ECMO DEVICE IN LIVER TRANSPLANTATION: AN ANALYSIS OF THE FIRST 100 CASES AT A CHILEAN PUBLIC HOSPITAL

Abstract

Conflict of interest: No Introduction and Objectives: Hypothermic machine perfusion using ECMO devices has emerged as a promising technique to enhance the viability of marginal liver grafts. This study aims to present the clinical outcomes of a series of 100 liver grafts subjected to this advanced preservation methods. Patients / Materials and Methods: A prospective analysis between October 2022 and May 2024 was conducted on 100 consecutive liver perfusion cases involving hypothermic perfusion with an ECMO device, followed by a subgroup comparison of regular and marginal grafts. Post-transplantation, key outcomes such as liver functionality, early complications, and overall survival were monitored in all patients. Statistical analyses included T-tests and Fisher's exact tests to evaluate differences in means and frequencies between groups. Results and Discussion: Three grafts were discarded due to severe steatosis. The patient cohort had a mean MELD Na score of 29.0 ± 8.72. The one-year survival rate was 82.7%. The major complication was infectious, observed in 57.7% of cases. The mean ICU and hospital stay was 10.98 ± 14.29 and 28.24 ± 24.78 days, respectively. Eighty-one liver grafts were categorized as regular (83.5%) and 16 as marginal (16.4%). Vascular complications were significantly more frequent in marginal grafts compared to regular grafts. No statistically significant differences in other clinical outcomes were observed between the regular and marginal graft groups (Table 1). Conclusions: The findings suggest that hypothermic perfusion using ECMO devices facilitates the safe utilization of marginal liver grafts. While the overall clinical outcomes are promising and comparable to international standards, the high incidence of infectious complications and extended ICU and hospital stays highlight significant areas for improvement. These challenges appear to be more related to the severity of the patient's conditions, as indicated by the elevated average MELD Na score, rather than the quality of the grafts. Therefore, hypothermic perfusion represents a viable strategy for expanding liver graft selection criteria in transplantation.