HOPE perfusion showed early graft survival signals in pediatric partial-graft liver transplantation, but data remain limited to small reports.
Hypothermic oxygenated machine perfusion (HOPE) using Bridge to Life’s VitaSmart system was associated with favorable early graft outcomes in a small series of pediatric partial-graft liver transplants presented at the 2026 annual meeting of the Society of Pediatric Liver Transplantation. The report adds pediatric data to a preservation strategy that has drawn increasing interest in adult liver transplantation, particularly for marginal grafts and donation after circulatory death organs.1,2
In the oral presentation, Karla Estefanía, MD, of Birmingham Children’s Hospital, said, “Our study with 17 pediatric liver recipients (12 split, 5 reduced) adds to the growing evidence supporting the ability of HOPE to improve donor liver quality in pediatric liver transplantation.” According to the presentation summary released by the company, death-censored graft survival was 100%, with no observed primary nonfunction or early ischemic-type biliary lesions, and cold ischemic time was reduced by an estimated 27%.
The Birmingham experience, titled “Hypothermic Oxygenated Machine Perfusion in the Use of Partial Grafts in Pediatric Liver Transplantation – Towards a New Standard of Care,” involved 17 pediatric recipients of partial grafts. The press release did not provide comparator-group details, follow-up duration, donor characteristics, or statistical methods, limiting assessment of effect size and generalizability. Still, the outcomes highlighted in the presentation address clinically important concerns in pediatric liver transplantation, where split and reduced grafts can expand the donor pool but may carry technical and ischemia-reperfusion risks.
Machine perfusion has been investigated as an alternative or adjunct to static cold storage to mitigate ischemia-reperfusion injury, improve graft assessment, and potentially lower biliary complications.^1,2 In adult liver transplantation, randomized and comparative studies have suggested benefits of oxygenated hypothermic perfusion, especially in higher-risk grafts, although protocols and devices vary.1,2 Pediatric evidence remains more limited and is often derived from single-center observational reports.
The company also highlighted 2 poster abstracts from La Paz University Hospital in Madrid. In one series of 35 pediatric cases that included donation after brain death and donation after circulatory death grafts, along with whole, reduced-size, single-segment, and hepatorenal transplants, investigators concluded that HOPE was a safe and effective strategy and had become standard practice in their program for suboptimal and complex grafts. A separate case report described auxiliary split-HOPE liver transplantation from a circulatory-death donor in a child with acute liver failure. These reports may be clinically relevant because pediatric centers often rely on technical variant grafts and must balance graft utilization with preservation-related risk, but abstract-level findings should be interpreted cautiously until full data are published.
For clinicians, the main question is whether HOPE can consistently improve outcomes enough to justify the added logistics, cost, and training required for machine perfusion. Pediatric liver transplantation already has high overall survival in experienced centers, but biliary complications, early allograft dysfunction, and organ scarcity remain significant challenges. Broader use of split, reduced, and circulatory-death grafts could help address wait-list mortality if preservation methods can maintain graft quality.3
The VitaSmart system is a hypothermic oxygenated perfusion platform designed for organ preservation. The press release did not specify current regulatory clearance or approval status for this pediatric liver-transplant use in the US or Europe. More broadly, ex vivo liver machine perfusion has been advancing through device- and protocol-specific development programs, but indications are not interchangeable across platforms or perfusion temperatures.1,2 Clinicians will likely want a peer-reviewed publication of the SPLIT data, including definitions of endpoints such as early ischemic-type biliary lesions, details on perfusion parameters, and matched controls or contemporaneous cold-storage comparators.
The report’s strengths are its focus on a difficult pediatric population and clinically meaningful endpoints, including graft survival and primary nonfunction. Its main limitations are the small sample size, conference-report format, and lack of granular safety data in the public summary. Whether the observed reduction in cold ischemic time reflects workflow changes, perfusion-related scheduling flexibility, or selection factors is also unclear from the available information.
If confirmed in larger multicenter cohorts, HOPE may become an important preservation option for partial pediatric liver grafts. For now, the SPLIT presentation should be viewed as early supportive evidence rather than practice-changing proof.
