Economic Evaluation of Prolonged Hypothermic Oxygenated Machine Perfusion Enabling Daytime Liver Transplantation

ABSTRACT Background Short‐duration (1–2 h) dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia‐reperfusion injury‐related complications. Prolonged DHOPE preservation (DHOPE‐PRO) may facilitate logistics. We assessed the economic impact of DHOPE‐PRO versus conventional short‐duration DHOPE, hypothesizing that DHOPE‐PRO would not be associated with increased one‐year transplantation‐related costs. Methods This post hoc economic evaluation of the prospective DHOPE‐PRO trial (NL8740) included adult recipients of livers donated after brain death. All transplantation‐related medical expenses up to one year post‐transplant were collected. The cost of resource use was calculated using 2022 full hospital prices indexed to 2024. Time‐driven variable costing was applied to perfusion, surgery, and intensive care costs. The primary outcome was total one‐year transplantation‐related cost. Results Of 24 patients, 12 received a liver after DHOPE and 12 after DHOPE‐PRO. Median one‐year total costs were €83 583 [interquartile range (IQR) 78 400–104 158] for DHOPE and €78 582 [IQR 73123–92 855] for DHOPE‐PRO ( p = 0.347). Perfusion costs were higher with DHOPE‐PRO (€23 926 [IQR 22711–24 697] versus €17 306 [IQR 16928–17 594]; p < 0.001), while surgery costs were lower (€18 560 [IQR 17806–20 747] versus €21 303 [IQR 19535–25 418]; p = 0.033). Costs related to other medical activities did not differ between groups. Conclusion In this exploratory single‐center economic evaluation, DHOPE‐PRO enabled daytime liver transplantation without evidence of increased one‐year transplantation‐related costs compared with short‐duration DHOPE. Higher perfusion‐related costs were accompanied by lower surgery‐related costs in this cohort. These findings warrant confirmation in larger studies. Trial Registration Netherlands Trial Registry number: NL8740