Normothermic perfusion: a new paradigm for organ preservation.
OBJECTIVE
Transplantation of organs retrieved after cardiac arrest could increase the donor organ supply. However, the combination of warm ischemia and cold preservation is highly detrimental to the reperfused organ. Our objective was to maintain physiological temperature and organ function during preservation and thereby alleviate this injury and allow successful transplantation.


BACKGROUND
We have developed a liver perfusion device that maintains physiological temperature with provision of oxygen and nutrition. Reperfusion experiments suggested that this allows recovery of ischemic damage.


METHODS
In a pig liver transplant model, we compared the outcome following either conventional cold preservation or warm preservation. Preservation periods of 5 and 20 hours and durations of warm ischemia of 40 and 60 minutes were tested.


RESULTS
After 20 hours preservation without warm ischemia, post-transplant survival was improved (27%-86%, P = 0.026), with corresponding differences in transaminase levels and histological analysis. With the addition of 40 minutes warm ischemia, the differences were even more marked (cold vs. warm groups 0% vs. 83%, P = 0.001). However, with 60 minutes warm ischemia and 20 hours preservation, there were no survivors. Analysis of hemodynamic and liver function data during perfusion showed several factors to be predictive of posttransplant survival, including bile production, base excess, portal vein flow, and hepatocellular enzymes.


CONCLUSIONS
Organ preservation by warm perfusion, maintaining physiological pressure and flow parameters, has enabled prolonged preservation and successful transplantation of both normal livers and those with substantial ischemic damage. This technique has the potential to address the shortage of organs for transplantation.
Brockmann
Jens
J
Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom.
Reddy
Srikanth
S
Coussios
Constantin
C
Pigott
David
D
Guirriero
Dino
D
Hughes
David
D
Morovat
Alireza
A
Roy
Debabrata
D
Winter
Lucy
L
Friend
Peter J
PJ
D000818:Animals; D001831:Body Temperature; D050377:Cold Ischemia; D007511:Ischemia / Q000628:therapy*; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D016031:Liver Transplantation; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D052096:Warm Ischemia