Advantages of normothermic perfusion over cold storage in liver preservation.
BACKGROUND
To minimize the ischemia-reperfusion injury that occurs to the liver with the current method of preservation and transplantation, we have used an extracorporeal circuit to preserve the liver with normothermic, oxygenated, sanguineous perfusion. In this study, we directly compared preservation by the standard method of simple cold storage in University of Wisconsin (UW) solution with preservation by perfusion.


METHODS
Porcine livers were harvested from large white sows weighing between 30 and 50 kg by the standard procedure for human retrieval. The livers were preserved for 24 hr by either cold storage in UW solution (n=5) or by perfusion with oxygenated autologous blood at body temperature (n=5). The extracorporeal circuit used included a centrifugal pump, heat exchanger, and oxygenator. Both groups were then tested on the circuit for a 24 hr reperfusion phase, analyzing synthetic function, metabolic capacity, hemodynamics, markers of hepatocyte and reperfusion injury, and histology.


RESULTS
Livers preserved with normothermic perfusion were significantly superior (P=0.05) to cold-stored livers in terms of bile production, factor V production, glucose metabolism, and galactose clearance. Cold-stored livers showed significantly higher levels of hepatocellular enzymes in the perfusate and were found to have significantly more damage by a blinded histological scoring system.


CONCLUSIONS
Normothermic sanguineous oxygenated perfusion is a superior method of preservation compared with simple cold storage in UW solution. In addition, perfusion allows the possibility to assess viability of the graft before transplantation.
Imber
Charles J
CJ
Nuffield Department of Surgery, Oxford University, Oxford, United Kingdom.
St  Peter
Shawn D
SD
Lopez de Cenarruzabeitia
Inigo
I
Pigott
Dave
D
James
Tim
T
Taylor
Richard
R
McGuire
James
J
Hughes
David
D
Butler
Andrew
A
Rees
Michael
M
Friend
Peter J
PJ
D000818:Animals; D003080:Cold Temperature; D006439:Hemodynamics; D008099:Liver / Q000378:metabolism / Q000473:pathology; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D010101:Oxygen Consumption; D010477:Perfusion; D015427:Reperfusion Injury / Q000517:prevention & control; D013552:Swine