title: Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers.
abstract: BACKGROUND
  The susceptibility of extended criteria livers to ischemia reperfusion injury is a major obstacle in organ cold preservation. Normothermic extracorporeal liver perfusion (NELP) has been investigated to reduce ischemic damage, restore physiologic function, and assess viability of the liver prior to transplant. The goal of this study is to compare physiological parameters of livers maintained continuously on NELP to those preserved in cold solution.
  
  
  METHODS
  Livers from 9 female landrace pigs were subjected to either 20 minutes (W20-NELP), 40 minutes (W40-NELP), or 60 minutes (W60-NELP) of warm ischemia followed by 6 hours of NELP followed by a 2-hour NELP evaluation phase. This was compared with 3 livers subjected to 40 minutes of warm ischemia time followed by 6 hours of cold storage (W40-Cold) and a 2-hour NELP evaluation phase. Groups were compared with the 2-way analysis of variance test.
  
  
  RESULTS
  NELP stabilized transaminases accompanied by significant improvement in bile production and decline in lactate and INR values in all W-NELP groups. Histologic analysis demonstrated significant improvement from 0 hour (mild-to-moderate sinusoidal dilation and zone 3 necrosis) to the end of the NELP run (minimal necrosis and mild IRI). Comparison of W40-NELP and W40-Cold revealed greater bile production and oxygen extraction ratio in W40-NELP. In contrast, markers of cellular and functional damage were increased in the W40-Cold group.
  
  
  CONCLUSIONS
  NELP improves metabolic and functional parameters of livers with either short or extended warm ischemia times compared with livers subjected to comparable cold ischemia times.
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Babak
authors: B
authors: Banan
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Haniee
authors: H
authors: Chung
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Zhenyu
authors: Z
authors: Xiao
authors: Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
authors: Yaman
authors: Y
authors: Tarabishy
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Jianluo
authors: J
authors: Jia
authors: Vasculox, Inc, St. Louis, MO.
authors: Pamela
authors: P
authors: Manning
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: G A
authors: GA
authors: Upadhya
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
authors: Thalachallour
authors: T
authors: Mohanakumar
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: liny@wudosis.wustl.edu.
authors: Yiing
authors: Y
authors: Lin
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: chapmanwi@wudosis.wustl.edu.
authors: William C
authors: WC
authors: Chapman
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology; D050377:Cold Ischemia; D003643:Death; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D008099:Liver / Q000098:blood supply* / Q000502:physiology; D008111:Liver Function Tests; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control; D013552:Swine; D013997:Time Factors; D009927:Tissue and Organ Procurement; D052096:Warm Ischemia