Original Article
Subnormothermic Machine Perfusion for Ex Vivo Preservation and Recovery of the Human Liver for Transplantation

https://doi.org/10.1111/ajt.12727Get rights and content
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To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pretransplantation. To determine the feasibility in human livers, we assessed the effect of 3 h of oxygenated subnormothermic machine perfusion (21°C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11–1.94] to 6.74 [4.15–8.16] mL O2/min kg liver), lactate levels (4.04 [3.70–5.99] to 2.29 [1.20–3.43] mmol/L) and adenosine triphosphate content (45.0 [70.6–87.5] pmol/mg preperfusion to 167.5 [151.5–237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production, was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters postischemia.

Key words:

Donation after circulatory death
liver transplantation
organ preservation
subnormothermic machine perfusion

Abbreviations

ALP
alkaline phosphatase
ALT
alanine aminotransferase
ATP
adenosine triphosphate
BGA
blood gas analysis
CIT
cold ischemia time
DBD
donation after brain death
DCD
donation after circulatory death
H&E
hematoxylin and eosin
HAR
hepatic artery resistance
HMP
hypothermic machine perfusion
LDH
lactate dehydrogenase
LFT
liver function test
NEOB
New England Organ Bank
NMP
normothermic machine perfusion
OUR
oxygen uptake rate
PVR
portal vein resistance
SNMP
subnormothermic machine perfusion
UW
University of Wisconsin
WIT
warm ischemia time

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Correction made after online publication April 23, 2014: author listing has been updated.