Ex vivo Normothermic Machine Perfusion and Viability Testing of Discarded Human Donor Livers

In contrast to traditional static cold preservation of donor livers, normothermic machine perfusion may reduce preservation injury, improve graft viability and potentially allows ex vivo assessment of graft viability before transplantation. We have studied the feasibility of normothermic machine per...

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Bibliographic Details
Published in:American journal of transplantation 2013-05, Vol.13 (5), p.1327-1335
Main Authors: op den Dries, S., Karimian, N., Sutton, M. E., Westerkamp, A. C., Nijsten, M. W. N., Gouw, A. S. H., Wiersema‐Buist, J., Lisman, T., Leuvenink, H. G. D., Porte, R. J.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Discarded human liver
Female
Follow-Up Studies
Graft Survival
Humans
Ischemic Preconditioning - methods
Liver - blood supply
Liver Transplantation
Liver, biliary tract, pancreas, portal circulation, spleen
machine perfusion
Male
Medical sciences
Middle Aged
normothermic
Organ Preservation - methods
Perfusion - methods
preservation
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Temperature
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Summary:In contrast to traditional static cold preservation of donor livers, normothermic machine perfusion may reduce preservation injury, improve graft viability and potentially allows ex vivo assessment of graft viability before transplantation. We have studied the feasibility of normothermic machine perfusion in four discarded human donor livers. Normothermic machine perfusion consisted of pressure and temperature controlled pulsatile perfusion of the hepatic artery and continuous portal perfusion for 6 h. Two hollow fiber membrane oxygenators provided oxygenation of the perfusion fluid. Biochemical markers in the perfusion fluid reflected minimal hepatic injury and improving function. Lactate levels decreased to normal values, reflecting active metabolism by the liver (mean lactate 10.0 ± 2.3 mmol/L at 30 min to 2.3 ± 1.2 mmol/L at 6 h). Bile production was observed throughout the 6 h perfusion period (mean rate 8.16 ± 0.65 g/h after the first hour). Histological examination before and after 6 h of perfusion showed well‐preserved liver morphology without signs of additional hepatocellular ischemia, biliary injury or sinusoidal damage. In conclusion, this study shows that normothermic machine perfusion of human donor livers is technically feasible. It allows assessment of graft viability before transplantation, which opens new avenues for organ selection, therapeutic interventions and preconditioning. This study demonstrates the technical feasibility of normothermic machine perfusion of human donor livers.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.12187