title: Excorporeal normothermic machine perfusion resuscitates pig DCD livers with extended warm ischemia.
abstract: BACKGROUND
  The shortage in donor livers has led to increased use of allografts derived from donation after cardiac death (DCD). The compromised viability in these livers leads to inferior post-transplantation allograft function and survival compared with donation after brain death (DBD) donor grafts. In this study, we reconditioned DCD livers using an optimized normothermic machine perfusion system.
  
  
  METHODS
  Livers from 12 Yorkshire pigs (20-30 kg) were subjected to either 0 min (WI-0 group, n = 6) or 60 min (WI-60 group, n = 6) of warm ischemia and 2 h of cold storage in UW solution, followed by 4 h of oxygenated sanguineous normothermic machine perfusion. Liver viability and metabolic function were analyzed hourly.
  
  
  RESULTS
  Warm ischemic livers showed elevated transaminase levels and reduced ATP concentration. After the start of machine perfusion, transaminase levels stabilized and there was recovery of tissue ATP, coinciding with an increase in bile production. These parameters reached comparable levels to the control group after 1 h of machine perfusion. Histology and gross morphology confirmed recovery of the ischemic allografts.
  
  
  CONCLUSIONS
  Our data demonstrate that metabolic and functional parameters of livers with extended warm ischemic time (60 min) can be significantly improved using normothermic machine perfusion. We hereby compound the existing body of evidence that machine perfusion is a viable solution for reconditioning marginal organs.
authors.affiliation: Transplantation Unit, Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. hongzhi2008@gmail.com
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Xu
authors.forename: Tim
authors.initials: T
authors.lastname: Berendsen
authors.forename: Karen
authors.initials: K
authors.lastname: Kim
authors.forename: Alejandro
authors.initials: A
authors.lastname: Soto-Gutiérrez
authors.forename: Francios
authors.initials: F
authors.lastname: Bertheium
authors.forename: Martin L
authors.initials: ML
authors.lastname: Yarmush
authors.forename: Martin
authors.initials: M
authors.lastname: Hertl
mesh_terms: D000818:Animals; D001646:Bile / Q000378:metabolism; D004734:Energy Metabolism; D006439:Hemodynamics; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D010477:Perfusion / Q000379:methods*; D013552:Swine; D052096:Warm Ischemia
chemical_list: D010100:Oxygen
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