title: Normothermic extracorporeal perfusion of isolated porcine liver after warm ischaemia: a preliminary report.
abstract: Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers. We conducted proof-of-concept experiments using a DCD model in the pig to assess the short-term (4 hours) feasibility and functional efficacy of NELP. Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation. Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.
authors.affiliation: Austin Hospital, Melbourne, VIC, Australia. rinaldo.bellomo@austin.org
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Bruno
authors.initials: B
authors.lastname: Marino
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Starkey
authors.forename: Brenton
authors.initials: B
authors.lastname: Chambers
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fink
authors.forename: Bao Zhong
authors.initials: BZ
authors.lastname: Wang
authors.forename: Shane
authors.initials: S
authors.lastname: Houston
authors.forename: Glenn
authors.initials: G
authors.lastname: Eastwood
authors.forename: Paolo
authors.initials: P
authors.lastname: Calzavacca
authors.forename: Neil
authors.initials: N
authors.lastname: Glassford
authors.forename: Alison
authors.initials: A
authors.lastname: Skene
authors.forename: Daryl A
authors.initials: DA
authors.lastname: Jones
authors.forename: Robert
authors.initials: R
authors.lastname: Jones
mesh_terms: D000082:Acetaminophen / Q000032:analysis; D000818:Animals; D005112:Extracorporeal Circulation; D008099:Liver / Q000473:pathology; D008102:Liver Circulation; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D013696:Temperature; D052096:Warm Ischemia
chemical_list: D000082:Acetaminophen