Key Takeaways
- Duke offers FDA-approved hypothermic-oxygenated perfusion (HOPE), which reduces graft dysfunction and improves graft survival compared with static cold storage.
- As a high-volume center, Duke offers both hypothermic and normothermic machine perfusion for donor livers, expanding the donor pool.
- Duke has transplanted more than 2000 livers since 1984, with median wait time to transplant for patients on the waitlist of 33 days, compared with 121 days nationally, and one-year conditional survival above the national average.
Multiple studies have shown hypothermic-oxygenated perfusion (HOPE) to be superior in decreasing early graft dysfunction and improving graft survival compared with static cold storage (SCS). Approved by the FDA in January 2026, HOPE offers another method for organ preservation, expanding access to transplant.
Duke Health has added HOPE to its liver transplant program, complementing normothermic machine perfusion. “We wanted to add another option to be able to accept as many livers as possible and preserve them as safely as possible,” says Duke abdominal transplant surgeon Andrew S. Barbas, MD.
Barbas adds that early referral can be key to excellent transplant outcomes. “Early referral is best for anyone with chronic liver disease,” he notes. “We can get patients seen in the Duke system and connect them to our multidisciplinary transplant team to watch them closely, and we’re happy to co-manage patients with referring providers.”
Expanding the donor pool
HOPE expands the criteria for accepted donor livers while maintaining excellent outcomes. “This allows us to safely use what were traditionally considered ‘high-risk’ donor livers,” says Barbas. The specific population that can be used includes:
- Older age donors
- Livers with some amount of fatty change
- Donation after circulatory death (DCD)
“Without these advanced preservation technologies, we would never be able to accept and safely transplant these organs,” Barbas explains. “HOPE allows us to achieve the same clinical outcomes with higher-risk donor livers because of the optimized organ preservation.”
Machine perfusion for liver transplant at Duke
Normothermic perfusion maintains the donor organ close to human body temperature, delivering oxygen using red blood cells from the blood bank. Hypothermic systems maintain organs at 4 to 12 degrees Celsius using an off-the-shelf perfusate. “Adding HOPE to our offerings allows us to better utilize our blood bank resources, which are always limited,” Barbas says.
Duke Liver Transplant Program uses both normothermic and hypothermic storage for donated livers. “Most centers can only invest in one of these technologies,” Barbas adds. “With multiple machines and technologies, we have the versatility to accept more organs.”
Duke continues to advance the science of liver transplant while maintaining excellent clinical care. Since 1984, Duke has transplanted more than 2000 livers. Duke’s median wait time to transplant for patients on the waitlist is 33 days, compared with 121 days nationally, with one-year conditional survival above the national average (Tables B10, C7D, and C7L; SRTR July 2026).