Applicability of Combined Use of Extracorporeal Support and Temperature-Controlled Machine Perfusion Preservation for Liver Procurement of Donors After Cardiac Death in Pigs.
BACKGROUND
The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. The objective of this study is to determine the benefits of extracorporeal membrane oxygenation (ECMO) and subnormothermic machine perfusion (MP) with rewarming in a large animal model of DCD liver.


METHODS
After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 60 minutes of cardiac death. Then the livers were perfused for 4 hours by MP as a graft viability test. In group 1, non-in situ ECMO and grafts were preserved hypothermic MP. In group 2, non-in situ ECMO and grafts were preserved subnormothermic rewarming MP. In group 3, we used ECMO and subnormothermic rewarming MP. To assess potential methods and effect, effluent enzymes were measured. Portal vein and hepatic artery pressure during MP were evaluated.


RESULTS
Effluent enzyme of AST, alanine aminotransferase and LDH as viability markers were significantly low (aspartate aminotransferase, 2899, 2292, and 972 IU/L; alanine aminotransferase, 134, 140, and 72 IU/L; and lactate dehydrogenase, 4354, 4455, and 1855 IU/L in each group, respectively). Portal vein and hepatic artery pressure during preservation came down smoothly in group 3 compared with group 1.


CONCLUSIONS
The combined use of in situ subnormothermic ECMO and machine preservation with rewarming is more essential for the recovery and resuscitating function of DCD liver grafts.
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
M
M
Hagiwara
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan. Electronic address: mtn@asahikawa-med.ac.jp.
N
N
Matsuno
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
L T
LT
Meng
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
M
M
Furukori
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
K
K
Watanabe
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
T
T
Shonaka
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
K
K
Imai
Department of Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan.
H
H
Obara
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Y
Y
Nishikawa
Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
H
H
Furukawa
D000818:Animals; D015925:Cryopreservation / Q000379:methods*; D003643:Death; D015199:Extracorporeal Membrane Oxygenation; D008099:Liver / Q000098:blood supply* / Q000378:metabolism; D016031:Liver Transplantation; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D017694:Rewarming; D013552:Swine; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*