title: Extracorporeal membrane oxygenation for resuscitation of deceased cardiac donor livers for hepatocyte isolation.
abstract: BACKGROUND
  Deceased cardiac donors (DCDs) have become a useful source of organs for liver transplantation; nevertheless, there are concerns about the longevity of these grafts. The aim of this study was to evaluate the use of extracorporeal membrane oxygenation (ECMO) to resuscitate DCD porcine livers as a preclinical model using hepatocyte isolation and viability as a marker to assess whole-graft preservation.
  
  
  METHODS
  We randomized Landrace pigs into three groups after cardiac death and 30 min of warm ischemia: group 1, peritoneal cooling with intravascular cooling for 2 h; group 2, ECMO for 2 h; and group 3, control (conventional intravascular cooling and retrieval). We then reperfused group 1 and 2 livers for 2 h on an ex vivo reperfusion circuit and isolated hepatocytes.
  
  
  RESULTS
  After reperfusion, hepatocyte viability was significantly improved in the ECMO group compared to the cooling groups, as measured by trypan blue, methylthiazolyldiphenyl-tetrazolium bromide, and seeding efficiency. Glycogen and reduced glutathione content were significantly used in the ECMO group both before and after reperfusion compared with group 2. The adenosine diphosphate:adenosine triphosphate ratio showed an improved trend (lower) in the ECMO group compared with the cooling group but did not reach statistical significance either before or after reperfusion.
  
  
  CONCLUSIONS
  This preclinical study suggests that ECMO is a viable technique for liver preservation that gives an improved yield of hepatocytes when isolated from a DCD liver, suggesting improved liver preservation.
authors: Department of Hepatobiliary and Liver Transplant Surgery, Institute of Cellular Medicine, Newcastle University, The Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, United Kingdom. saleem.noormohamed@gmail.com
authors: Mohamed S
authors: MS
authors: Noormohamed
authors: Aditya
authors: A
authors: Kanwar
authors: Christopher
authors: C
authors: Ray
authors: Matthew C
authors: MC
authors: Wright
authors: David E
authors: DE
authors: Cowie
authors: Susan
authors: S
authors: Stamp
authors: David
authors: D
authors: Talbot
authors: Derek
authors: D
authors: Manas
authors: Steven A
authors: SA
authors: White
mesh_terms: D000818:Animals; D002469:Cell Separation; D002470:Cell Survival / Q000502:physiology; D003643:Death; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D022781:Hepatocytes / Q000166:cytology / Q000502:physiology*; D008099:Liver / Q000166:cytology / Q000502:physiology*; D016031:Liver Transplantation / Q000379:methods*; D023421:Models, Animal; D012151:Resuscitation / Q000379:methods*; D013552:Swine; D014019:Tissue Donors
keywords: Biliary stricture; Hepatocyte transplantation; Liver transplant; NHBD; Organ donor; Preservation