title: A novel oxygenated machine perfusion system for preservation of the liver.
abstract: Machine perfusion (MP) is a potential method to increase the donor pool for organ transplantation. However, MP systems for liver grafts remain difficult to use because of organ-specific demands. Our aim was to test a novel, portable MP system for hypothermic preservation of the liver. A portable, pressure-regulated, oxygenated MP system designed for kidney preservation was adapted to perfuse liver grafts via the portal vein (PV). Three porcine livers underwent 20 h of hypothermic perfusion using Belzer MP solution. The MP system was assessed for perfusate flow, temperature, venous pressure, and pO2 /pCO2 during the preservation period. Biochemical and histological parameters were analyzed to determine postpreservation organ damage. Perfusate flow through the PV increased over time from 157 ± 25 mL/min at start to 177 ± 25 mL/min after 20 h. PV pressure remained stable at 13 ± 1 mm Hg. Perfusate temperature increased from 9.7 ± 0.6°C at the start to 11.0 ± 0.0°C after 20 h. Aspartate aminotransferase and lactate dehydrogenase increased from 281 ± 158 and 308 ± 171 U/L after 1 h to 524 ± 163 and 537 ± 168 U/L after 20 h, respectively. Blood gas analysis showed a stable pO2 of 338 ± 20 mm Hg before perfusion of the liver and 125 ± 14 mm Hg after 1 h perfusion. The pCO2 increased from 15 ± 5 mm Hg after 1 h to 53 ± 4 mm Hg after 20 h. No histological changes were found after 20 h of MP. This study demonstrated the feasibility of a portable MP system for preservation of the liver and showed that continuous perfusion via the PV can be maintained with an oxygen-driven pump system without notable preservation damage of the organ.
authors.affiliation: Department of Surgery (Surgical Laboratory), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Marcel C
authors.initials: MC
authors.lastname: Dirkes
authors.forename: Ivo C J H
authors.initials: IC
authors.lastname: Post
authors.forename: Michal
authors.initials: M
authors.lastname: Heger
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000241:Adenosine / Q000378:metabolism; D000493:Allopurinol / Q000378:metabolism; D000818:Animals; D001784:Blood Gas Analysis; D003080:Cold Temperature; D004867:Equipment Design; D005260:Female; D005978:Glutathione / Q000378:metabolism; D007328:Insulin / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000502:physiology* / Q000648:ultrastructure; D009926:Organ Preservation / Q000295:instrumentation*; D019188:Organ Preservation Solutions / Q000378:metabolism; D010100:Oxygen / Q000097:blood / Q000378:metabolism; D010477:Perfusion / Q000295:instrumentation*; D011887:Raffinose / Q000378:metabolism; D013552:Swine
chemical_list: D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose; D010100:Oxygen
keywords: Extracorporeal hypothermic machine perfusion; Liver and kidney transplantation; Organ preservation