title: Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers.
abstract: The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured.
authors.affiliation: Laboratory of Abdominal Transplant Surgery, Catholic University of Leuven, Leuven, Belgium. diethard.monbaliu@uz.kuleuven.ac.be
authors.forename: Diethard
authors.initials: D
authors.lastname: Monbaliu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.forename: Louis
authors.initials: L
authors.lastname: Libbrecht
authors.forename: Rita
authors.initials: R
authors.lastname: De Vos
authors.forename: Katrien
authors.initials: K
authors.lastname: Vekemans
authors.forename: Charlotte
authors.initials: C
authors.lastname: Debbaut
authors.forename: Olivier
authors.initials: O
authors.lastname: Detry
authors.forename: Tania
authors.initials: T
authors.lastname: Roskams
authors.forename: Jos
authors.initials: J
authors.lastname: van Pelt
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002245:Carbon Dioxide / Q000378:metabolism; D003080:Cold Temperature; D004867:Equipment Design; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D019344:Lactic Acid / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism / Q000648:ultrastructure; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D010100:Oxygen / Q000378:metabolism; D010313:Partial Pressure; D010477:Perfusion / Q000295:instrumentation; D012333:RNA, Messenger / Q000378:metabolism; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014655:Vascular Resistance; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019188:Organ Preservation Solutions; D012333:RNA, Messenger; D002245:Carbon Dioxide; D019344:Lactic Acid; D000255:Adenosine Triphosphate; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D010100:Oxygen