title: A new liver autotransplantation technique using subnormothermic machine perfusion for organ preservation in a porcine model.
abstract: BACKGROUND
  Hepatic resection is the gold standard of therapy for primary and secondary liver tumors, but few patients are eligible for this procedure because of the extent of their neoplasms. Improvements in surgical experience of liver transplantation (OLT), hepatic resection and preservation with sub-normothermic machine perfusion (MP) have prompted the development of a new model of large animal autotransplantation.
  
  
  METHODS
  Landrace pigs were used in this experiment. After intubation, hepatectomy was performed according to the classic technique. The intrahepatic caval vein was replaced with a homologous tract of porcine thoracic aorta. The liver was perfused with hypothermic Celsior solution followed by MP at 20 °C with oxygenated Krebs solution. An hepatectomy was performed during the period of preservation, which lasted 120 minutes, then the liver was reimplanted into the same animal in a 90° counterclockwise rotated position. The anastomoses were performed in the classic sequence. Samples of intravascular fluid, blood and liver biopsies were obtained at the end of the period of preservation in MP and again at 1 and 3 hours after liver reperfusion to evaluate graft function and microscopic damage.
  
  
  RESULTS
  All animals survived the procedure. The peak of aspartate aminotransferase was recorded 60 minutes after reperfusion and the peak of alanine aminotransferase and lactate dehydrogenase after 180 minutes. Histopathologic examination under the light microscope identified no necrosis or congestion. Intraoperative echo-color Doppler documented good patency of the anastomosis and normal venous drainage.
  
  
  CONCLUSIONS
  This system made it possible to perform hepatic resections and vascular reconstructions ex situ while preserving the organ with mechanical perfusion (ex vivo, ex situ surgery). Improving surgical techniques regarding autotransplantation and our understanding of ischemia-reperfusion damage may enable the development of interesting scenarios for aggressive surgical treatment or radiochemotherapy options to treat primary and secondary liver tumors unsuitable for conventional in situ surgery.
authors.affiliation: Department of Surgical and Gastroenterological Sciences, Hepatobiliary and Liver Transplant Unit, University of Padova, Italy. enrico.gringeri@unipd.it
authors.forename: E
authors.initials: E
authors.lastname: Gringeri
authors.forename: M
authors.initials: M
authors.lastname: Polacco
authors.forename: F E
authors.initials: FE
authors.lastname: D'Amico
authors.forename: M
authors.initials: M
authors.lastname: Scopelliti
authors.forename: D
authors.initials: D
authors.lastname: Bassi
authors.forename: P
authors.initials: P
authors.lastname: Bonsignore
authors.forename: R
authors.initials: R
authors.lastname: Luisetto
authors.forename: E
authors.initials: E
authors.lastname: Lodo
authors.forename: A
authors.initials: A
authors.lastname: Carraro
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: U
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004187:Disaccharides / Q000008:administration & dosage / Q000009:adverse effects; D004573:Electrolytes / Q000008:administration & dosage / Q000009:adverse effects; D005971:Glutamates / Q000008:administration & dosage / Q000009:adverse effects; D005978:Glutathione / Q000008:administration & dosage / Q000009:adverse effects; D006498:Hepatectomy / Q000009:adverse effects; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006639:Histidine / Q000008:administration & dosage / Q000009:adverse effects; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects; D023421:Models, Animal; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D010477:Perfusion / Q000009:adverse effects; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D015427:Reperfusion Injury / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D012092:Replantation; D013552:Swine; D013696:Temperature; D013997:Time Factors; D014182:Transplantation, Autologous; D018615:Ultrasonography, Doppler, Color; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D015415:Biomarkers; C088453:Celsior; D004187:Disaccharides; D004573:Electrolytes; D005971:Glutamates; D007552:Isotonic Solutions; C051865:Krebs-Ringer solution; D019188:Organ Preservation Solutions; D008353:Mannitol; D006639:Histidine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D005978:Glutathione