ISRCTN ISRCTN15527114
DOI https://doi.org/10.1186/ISRCTN15527114
EudraCT/CTIS number 2016-002540-16
ClinicalTrials.gov number NCT01317342
Secondary identifying numbers 2011-0079/4
Submission date
12/03/2017
Registration date
07/12/2017
Last edited
01/03/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Surgery
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
The life of many people strictly depends on a new liver. Unfortunately, there are not enough organs for all potential recipients on the waiting list. Livers of lower quality with a higher risk of functional impairment after transplantation therefore have to be used. The aim is therefore to improve the quality and function of such livers. Hypothermic oxygenated perfusion (HOPE) is organ perfusion with a cold perfusion solution with a lot of oxygen. Following routine liver transport in the cold (standard cold storage), livers undergo a short, cold perfusion for 1-2 hours before implantation. The machine used for this has been introduced into the field of liver transplantation and is used in many centres worldwide. A short, cold and oxygenated liver perfusion before transplantation improves the function of the liver in the recipient. These results have been confirmed internationally. The aim of this study is to improve liver function after transplantation by using a short and cold machine perfusion and analyse outcomes and complications after liver transplantation.

Who can participate?
Patients aged 18 or above who are receiving a liver transplant

What does the study involve?
Livers are randomly allocated into two groups to undergo either conventional cold storage or cold storage plus HOPE before implantation. The liver recipients are followed up to assess complications, liver function, length of hospital and ICU stay, and patient and transplant survival at 1 year.

What are the possible benefits and risks of participating?
Participation may improve the function of the new liver and the results will help liver recipients in the future, as more patients will receive a new liver with a better function, outcome and survival in the future. The perfusion solution is produced synthetically, sterile and has not been retrieved from another living organism. Participants are therefore not exposed to a higher risk for transmission of HIV or hepatitis virus infections. During and after the transplant procedure, several blood tests and liver biopsies (samples) are regularly necessary. There are no changes from the standard procedure after liver transplantation during participation in this study. The medical treatment including immunosuppression is not influenced by the study. All liver recipients get standard immunosuppression, with or without participation in the study. The overall risk for participants is very small. Occurrence of unexpected risks is unlikely but cannot be completely excluded. More than 120 livers have been transplanted after this perfusion technique worldwide (in Switzerland, USA, Italy and Netherlands), where no specific unexpected side effects have been reported yet.

Where is the study run from?
The study takes place at University Hospital Zurich (Switzerland) and 8-10 other centres in Europe, for example in Birmingham (QEHB), London (King’s College Hospital) and Edinburgh (UK).

When is the study starting and how long is it expected to run for?
April 2016 to July 2019

Who is funding the study?
Swiss National Science Foundation (Switzerland)

Who is the main contact?
Dr Andrea Schlegel

Study website

Contact information

Dr Andrea Schlegel
Scientific

Mindelsohn Way
Edgbaston
Birmingham
B15 2TH
United Kingdom

Study information

Study designMulticenter randomized controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet ISRCTN15527114_PIS_17Aug17.pdf
Scientific titleHypothermic oxygenated perfusion (HOPE) of human liver grafts before transplantation - A multicenter, randomized controlled trial
Study acronymHOPE study
Study objectivesThe purpose of this study is, in a phase II randomized trial, to test a newly developed machine perfusion technique of human liver allografts before transplantation. Significance of planned research: Late biliary injury and graft loss remain a major problem in the era of sick liver transplant recipients and marginal donors. Machine liver perfusion techniques have been recognized as potentially protective, but are still not in use in human liver transplantation, because of low practicability and lack of prospective human studies. The suggested study will demonstrate, for the first time worldwide, the effect of an easy and applicable perfusion technique in human liver grafts. The trialists postulate, therefore, a high acceptance rate among transplant surgeons. In case of convincing success, it can be applied at low cost and low resources in any center worldwide.
Ethics approval(s)Kantonal Ethical Commission Zurich, Switzerland, 06/09/2011, ref: KEKZH2011-0079(KEK-ZH-Nr.2011-0079/4
Health condition(s) or problem(s) studiedLiver transplantation
InterventionRandomization will be performed at the time of liver acceptance. This is usually also the time when the liver recipient is admitted to hospital. The liver will be randomized by the local investigator or the trial coordinator using an online randomization tool. A computer-generated list of random assignments (block randomization per center (www.randomizer.at) is prepared in advance. Hence, concealed allocation will not be possible. The timepoint for randomization will be at the end of procurement to assure a minimum dropout of cases. The procurement team will call the local or principal investigator, who coordinates the randomization in that center. The randomization list from the randomizer has been incorporated into the newly developed eCRF. All personnel involved in randomization will be trained in the use of the online randomization by the Project Leader or the Principal Investigator of each site.

Liver grafts from brain death donors (DBD) will be randomly divided in two groups, receiving either conventional cold storage (n=85) according to standard criteria of organ preservation or cold storage plus subsequent hypothermic oxygenated perfusion (HOPE), performed ex-situ with the liver assist device, before implantation (n=85).

Follow up of each included patient will be 12 months.
Intervention typeDevice
Pharmaceutical study type(s)
PhasePhase II
Drug / device / biological / vaccine name(s)
Primary outcome measureMajor postoperative complications (Clavien Grade > or =III), using the established Clavien classification supported by a recently developed comprehensive complication index (CCI). Complications are summarized in the eCRF from the time of transplantation until 1 year after liver transplantation, which is the end of follow up. In the eCRF complications are monitored during hospital stay, at 3 and 6 and 9 and 12-month outpatient controls after liver transplantation.
Secondary outcome measures1. Plasma AST and ALT, measured 6 and 12 hours after OLT, and at day 1-7 postoperatively to determine the area under the curve (AUC)
2. Postoperative liver function measured by INR (plasma, at day 1-7)
3. Intra- and extrahepatic biliary complications within the first year after liver transplantation, assessed by serum cholestasis parameters (Bilirubin, Gammaglutamyltransferase, Alkaline Phosphatase) every 3 months and liver MRI including an MCRP 12 months after liver transplantation
4. Length of hospital and ICU stay after transplantation
5. Patient and graft survival at 1 year
Overall study start date01/04/2016
Completion date31/07/2019

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants170
Key inclusion criteria1. Candidates for liver transplantation
2. Aged 18 or above
3. Receiving a whole liver graft
4. Full consent for the study
Key exclusion criteria1. DCD livers
2. Split grafts
3. Living donor livers
4. Combined grafts
5. Domino liver transplantations
6. Cold storage of more than 12 hrs
Date of first enrolment01/04/2016
Date of final enrolment01/05/2018

Locations

Countries of recruitment

  • Belgium
  • England
  • France
  • Germany
  • Netherlands
  • Romania
  • Scotland
  • Spain
  • Switzerland
  • United Kingdom

Study participating centres

Queen Elizabeth Hospital Birmingham
B15 2TH
United Kingdom
University Hospital Zurich
8091
Switzerland
King's College Hospital
London
SE5 9RS
United Kingdom
Royal Infirmary of Edinburgh
EH16 4SA
United Kingdom
Hospital Universitario “Reina Sofia”
Cordoba
14004
Spain
University of Medicine “Carol Davila”
Fundeni Clinical Institute
Bucharest
030167
Romania
Klinik für Allgemeine und Transplantationschirurgie - University Hospital Essen
45147
Germany
Universitaire Ziekenhuizen Leuven
Abdominal Transplant Surgery
B-3000
Belgium
Erasmus Medical Centre
Rotterdam
3015 CE
Netherlands
University Medical Centre Groningen
9713 GZ
Netherlands

Sponsor information

University Hospital Zurich
Hospital/treatment centre

Raemistrasse 100
Zurich
8091
Switzerland

Phone +41 (0)442 551 111
Email andrea.schlegel@usz.ch
ROR logo "ROR" https://ror.org/01462r250

Funders

Funder type

Research organisation

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Private sector organisation / Trusts, charities, foundations (both public and private)
Alternative name(s)
Schweizerischer Nationalfonds, Swiss National Science Foundation, Fonds National Suisse de la Recherche Scientifique, Fondo Nazionale Svizzero per la Ricerca Scientifica, Fonds National Suisse, Fondo Nazionale Svizzero, Schweizerische Nationalfonds, SNF, SNSF, FNS
Location
Switzerland

Results and Publications

Intention to publish date01/09/2019
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryStored in repository
Publication and dissemination planPublication following interim analysis when 40 patients have been randomized into the study, and final publication when the study has been completed. Publication is expected in summer/autumn 2019.
IPD sharing planParticipants data will be collected in an electronic case report form (eCRF) and will be available for a few investigators per centre and the sponsor. Importantly, investigators will exclusively have access to participants data from their own centre. When eCRF training has been completed successfully, the personal password and login details are provided by the clinical trial centre in Zurich, Switzerland (Sponsor, leading trial coordinator) just after the centre received the ethical approval prior to start with the inclusion of patients. Participants give consent to use their data after transplantation, which will exclusively be used for the trial and are not accessible for any other purpose. Data are completely anonymised and trial numbers are allocated to each participant by the eCRF system automatically.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Participant information sheet 17/08/2017 07/12/2017 No Yes

Additional files

ISRCTN15527114_PIS_17Aug17.pdf
Uploaded 07/12/2017

Editorial Notes

01/03/2019: Internal review.