Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation.
To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pretransplantation. To determine the feasibility in human livers, we assessed the effect of 3 h of oxygenated subnormothermic machine perfusion (21°C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11-1.94] to 6.74 [4.15-8.16] mL O2 /min kg liver), lactate levels (4.04 [3.70-5.99] to 2.29 [1.20-3.43] mmol/L) and adenosine triphosphate content (45.0 [70.6-87.5] pmol/mg preperfusion to 167.5 [151.5-237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production, was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters postischemia.
Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Surgery (Surgical Laboratory), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
B G
BG
Bruinsma
H
H
Yeh
S
S
Ozer
P N
PN
Martins
A
A
Farmer
W
W
Wu
N
N
Saeidi
S
S
Op den Dries
T A
TA
Berendsen
R N
RN
Smith
J F
JF
Markmann
R J
RJ
Porte
M L
ML
Yarmush
K
K
Uygun
M-L
ML
Izamis
D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000503:physiopathology; D015925:Cryopreservation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*
D000255:Adenosine Triphosphate
Donation after circulatory death; liver transplantation; organ preservation; subnormothermic machine perfusion