title: Impact of Temperature on Porcine Liver Machine Perfusion From Donors After Cardiac Death.
abstract: Normothermic machine perfusion (NMP) has been introduced as a promising technology to preserve and possibly repair marginal liver grafts. The aim of this study was to compare the effect of temperature on the preservation of donation after cardiac death (DCD) liver grafts in an ex vivo perfusion model after NMP (38.5°C) and subnormothermic machine perfusion (SNMP, 21°C) with a control group preserved by cold storage (CS, 4°C). Fifteen porcine livers with 60 min of warm ischemia were preserved for 10 h by NMP, SNMP or CS (n = 5/group). After the preservation phase all livers were reperfused for 24 h in an isolated perfusion system with whole blood at 38.5°C to simulate transplantation. At the end of transplant simulation, the NMP group showed significantly lower hepatocellular enzyme level (AST: 277 ± 69 U/L; ALT: 22 ± 2 U/L; P < 0.03) compared to both SNMP (AST: 3243 ± 1048 U/L; ALT: 127 ± 70 U/L) and CS (AST: 3150 ± 1546 U/L; ALT: 185 ± 97 U/L). There was no significant difference between SNMP and CS. Bile production was significantly higher in the NMP group (219 ± 43 mL; P < 0.01) compared to both SNMP (49 ± 84 mL) and CS (12 ± 16 mL) with no significant difference between the latter two groups. Histologically, the NMP livers showed preserved cellular architecture compared to the SNMP and CS groups. NMP was able to recover DCD livers showing superior hepatocellular integrity, biliary function, and microcirculation compared to SNMP and CS. SNMP showed some significant benefit over CS, yet has not shown any advantage over NMP.
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nassar
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Farias
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Buccini
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: William
authors.initials: W
authors.lastname: Baldwin
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Mangino
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Irefin
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Jacek
authors.initials: J
authors.lastname: Cywinski
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago Uso
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iuppa
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Basem
authors.initials: B
authors.lastname: Soliman
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.affiliation: Transplantation Center, Cleveland Clinic Foundation, Cleveland, OH, USA. quintic@ccf.org.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
mesh_terms: D000818:Animals; D005260:Female; D008099:Liver / Q000201:enzymology / Q000502:physiology* / Q000648:ultrastructure*; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D013552:Swine; D013696:Temperature; D020858:Tissue and Organ Harvesting / Q000379:methods; D052096:Warm Ischemia / Q000379:methods
keywords: Liver-Normothermic machine perfusion-Donation after cardiac death-Ex vivo