Liver transplantation after organ preservation with normothermic extracorporeal perfusion.
OBJECTIVE
To study normothermic extracorporeal liver perfusion (NELP) as a means to preserve livers for transplantation and to reverse warm ischemic injury.


BACKGROUND
The authors provide experimental evidence that successful transplantation after 4 hours of normothermic extracorporeal liver perfusion is possible and as reliable as 4 hours of cold preservation in University of Wisconsin solution. NELP preserves liver function completely and can reverse 60 minutes of warm ischemic injury in non-heart-beating donors.


METHODS
Thirty-six German Landrace pigs received transplants in six groups. Group 1 animals received direct transplantation. Group 2 received transplants after 4 hours of cold preservation with University of Wisconsin solution and Group 3 animals after 4 hours of NELP. Group 4 animals sustained 1 hour of warm ischemia before transplantation. Group 5 animals received transplants after 1 hour of warm ischemia and 4 hours of cold preservation and Group 6 animals after 1 hour of warm ischemia and 4 hours of NELP.


RESULTS
All animals receiving livers treated by NELP survived more than 7 days after the transplant (Groups 3 and 6). In contrast, all animals in Group 5 developed primary graft nonfunction within 24 hours after transplantation.


CONCLUSIONS
The technique of NELP holds the potential to keep a mammalian liver outside the body completely functional, possibly for more than 4 hours. NELP can be used for liver preservation before transplantation or for the use of organs from non-heart-beating donors.
Schön
M R
MR
Departments of Surgery, Charité, Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany. michael.schoen@charite.de
Kollmar
O
O
Wolf
S
S
Schrem
H
H
Matthes
M
M
Akkoc
N
N
Schnoy
N C
NC
Neuhaus
P
P
D000818:Animals; D004867:Equipment Design; D006085:Graft Survival; D019194:Ischemic Preconditioning; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008854:Microscopy, Electron; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation*; D018709:Statistics, Nonparametric; D013552:Swine