*Purpose: Hypothermic oxygenated machine perfusion (HMP-O₂) is a novel liver preservation technique currently in clinical trials. It has the potential to mitigate ischemia/reperfusion injury, as well as improve organ function and patient outcomes. Here we present preliminary results from two collaborating centers within the PILOT trial (NCT03484455), a prospective, multi-center randomized controlled trial comparing HMP-O₂ vs Static Cold Storage (SCS), using the Lifeport Liver Transporter (LLT) (Organ Recovery Systems, Itasca, IL).

*Methods: Study patients were randomized to SCS or HMP-O₂. The HMP perfusate was actively oxygenated using “oxygen pre-charge” (OPC) prior to initiation of perfusion. Liver tissue samples and perfusate were collected. Operative and postoperative care was per institutional protocol, and postoperative parameters were followed. Adverse events (AEs) were tracked; re-operations, hospital re-admissions, and biliary complications were considered severe (SAEs). Statistical analysis was performed using SPSS v26 and GraphPad Prism v8.3.0; p<0.05 was considered significant.

*Results: 26 SCS and 13 HMP-O₂ cases were analyzed. Donor and recipient age, match MELD, BMI and anastomotic time were similar between groups. Cold ischemia time (CIT) was greater for HMP-O₂ (7 vs 5.1 hrs, p=0.0001). One recipient of a DCD liver in the SCS cohort had PNF and expired on POD1. Early allograft dysfunction (EAD) occurred in 2/13 HMP-O₂ and 5/26 SCS cases. The incidence of SAEs, particularly biliary complications (BC), was higher in the SCS arm (p<0.05 and p=0.006, respectively; Figure 1). This was independent of ischemia times and donor/recipient parameters.

*Conclusions: HMP-O₂ appears to be a safe and effective preservation method. Early results from two centers in the PILOT trial demonstrate several improved short-term outcomes. Further study is needed to fully characterize the benefits of HMP-O₂ in Liver Transplantation.

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