Successful extracorporeal porcine liver perfusion for 72 hr.
BACKGROUND
Improvements in extracorporeal perfusion technology and the production of transgenic pigs resistant to hyperacute rejection have stimulated several groups to re-explore the possibility of supporting patients in hepatic failure with extracorporeal porcine livers. The success of organ transplantation has also stimulated interest in using extracorporeal perfusion as a means of organ preservation and resuscitation of organs from marginal donors. The present study describes a method by which livers can be maintained in a viable condition for a minimum of 72 hr of normothermic, extracorporeal perfusion.


METHODS
Five extracorporeal porcine liver perfusions were performed, each with a duration of 72 hr. Hepatectomy was performed, followed by cold preservation, cannulation of vessels, and initiation of perfusion with normothermic, oxygenated porcine blood. Organ viability was assessed by metabolic, synthetic, hemodynamic, and histologic parameters.


RESULTS
After 72 hr of normothermic, extracorporeal perfusion, the isolated livers demonstrated maintenance of normal physiological levels of pH and electrolytes. Continued hepatic protein synthesis (complement and factor V) was maintained throughout the perfusion. Hemodynamic parameters remained within normal physiological range. Histology demonstrated good preservation of the liver with no overall architectural change.


CONCLUSIONS
It is possible to maintain a liver in a viable condition for a minimum of 72 hr of extracorporeal perfusion. This technique has been developed primarily as a preclinical model of extracorporeal liver support with the intention of proceeding to a clinical trial in patients with fulminant liver failure. However, it also has potential applications in organ preservation or resuscitation before transplantation and in the experimental study of isolated liver physiology.
Butler
Andrew J
AJ
Department of Surgery, University of Cambridge, Addenbrooke's Hospital, CB2 2QQ Cambridge, United Kingdom.
Rees
Michael A
MA
Wight
Derek G D
DG
Casey
Neil D
ND
Alexander
Graeme
G
White
David J G
DJ
Friend
Peter J
PJ
D000818:Animals; D003165:Complement System Proteins / Q000096:biosynthesis; D004573:Electrolytes / Q000378:metabolism; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005165:Factor V / Q000096:biosynthesis; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000502:physiology; D008102:Liver Circulation / Q000502:physiology; D009926:Organ Preservation / Q000379:methods; D012016:Reference Values; D012039:Regional Blood Flow; D013552:Swine; D013997:Time Factors
D004573:Electrolytes; D005165:Factor V; D003165:Complement System Proteins