Predictive value of portal fibrosis and inflammation in transplanted liver grafts treated with hypothermic oxygenated perfusion

Background: Hypothermic oxygenated perfusion (HOPE) has become widespread for the preservation of liver grafts, making tangled the relationship among the use of extended criteria donors (ECD), graft histology and transplant outcome.Aims: To prospectively validate the impact of the graft histology on transplant outcome in recipient receiving liver grafts from ECD after HOPE.Methods: Ninety-three ECD grafts were prospectively enrolled; 49 (52.7 %) were perfused with HOPE according to our protocols. All clinical, histological and follow-up data were collected.Results: Grafts with portal fibrosis stage = 3 according to Ishak's (evaluated with Reticulin stain) had a significantly higher incidence of early allograft dysfunction (EAD) and 6-month-dysfunction (p = 0.026 and p = 0.049), with more days in Intensive Care Unit (p = 0.050). Lobular fibrosis correlated with post-liver transplant kidney function (p = 0.019). Moderate-to-severe chronic portal inflammation was correlated with graft survival on both multivariate and univariate analyses (p < 0.001), but this risk factor is sensibly reduced by the execution of HOPE.Conclusions: The use of liver grafts with portal fibrosis stage = 3 implies a higher risk of post-transplant complications. Portal inflammation represents an important prognostic factor as well, but the execution of HOPE represents a valid tool to improve graft survival.