title: Extended normothermic extracorporeal perfusion of isolated human liver after warm ischaemia: a preliminary report.
abstract: BACKGROUND
  Donation after circulatory death (DCD) livers are at markedly increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to transplant DCD livers and may allow their use for artificial extracorporeal liver support of patients with fulminant liver failure.
  
  
  OBJECTIVE
  We conducted two proof-of-concept experiments using human livers after DCD to assess the feasibility and functional efficacy of NELP over an extended period.
  
  
  METHODS
  We applied extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion and physiological perfusion pressures to two livers obtained after DCD.
  
  
  RESULTS
  We achieved NELP and evidence of liver function (bile production, paracetamol removal and maintenance of normal lactate levels) in both livers; one for 24 hours and the other for 43 hours. Histological examination showed areas of patchy ischaemia but preserved biliary ducts and canaliculi.
  
  
  CONCLUSIONS
  Our experiments justify further investigations of the feasibility and efficacy of extended DCD liver preservation by ex-vivo perfusion.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Perfusion Services, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Bruno
authors.initials: B
authors.lastname: Marino
authors.affiliation: Department of Liver Transplantation Surgery, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Starkey
authors.affiliation: Department of Liver Transplantation Surgery, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Fink
authors.affiliation: Department of Liver Transplantation Surgery, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Bao Zhong
authors.initials: BZ
authors.lastname: Wang
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Leah
authors.initials: L
authors.lastname: Peck
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Young
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Houston
authors.affiliation: Department of Anatomical Pathology, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Skene
authors.affiliation: Donate Life Victoria, Melbourne, VIC, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Opdam
authors.affiliation: Department of Liver Transplantation Surgery, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Jones
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D007511:Ischemia; D008099:Liver / Q000098:blood supply / Q000166:cytology / Q000502:physiology*; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D013997:Time Factors; D009927:Tissue and Organ Procurement; D052096:Warm Ischemia