title: Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death.
abstract: Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57-year-old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life-supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma-free red cell-based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia.
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: C J E
authors.initials: CJ
authors.lastname: Watson
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: V
authors.initials: V
authors.lastname: Kosmoliaptsis
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: L V
authors.initials: LV
authors.lastname: Randle
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: N K
authors.initials: NK
authors.lastname: Russell
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: W J H
authors.initials: WJ
authors.lastname: Griffiths
authors.affiliation: Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Davies
authors.affiliation: The Liver Unit, University Hospital, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mergental
authors.affiliation: Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Butler
mesh_terms: D006323:Heart Arrest; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D010477:Perfusion; D011379:Prognosis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: Preimplant ex situ normothermic liver perfusion; donation after circulatory death; liver transplantation