The 24-hour normothermic machine perfusion of discarded human liver grafts.
Donor organ shortage necessitates use of less than optimal donor allografts for transplantation. The current cold storage preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation (NMP) of liver allografts. In this study, we analyze discarded human liver grafts that underwent NMP for the extended period of 24 hours. Thirteen human liver grafts which had been discarded for transplantation were entered into this study. Perfusion was performed with an automated device using an oxygenated, sanguineous perfusion solution at normothermia. Automated control was incorporated for temperature-, flow-, and pressure-regulation as well as oxygenation. All livers were perfused for 24 hours; parameters of biochemical and synthetic liver function as well as histological parameters of liver damage were analyzed. Livers were stratified for expected viability according to the donor's medical history, procurement data, and their macroscopic appearance. Normothermic perfusion preservation of human livers for 24 hours was shown to be technically feasible. Human liver grafts, all of which had been discarded for transplantation, showed levels suggesting organ viability with respect to metabolic and synthetic liver function (to varying degrees). There was positive correlation between instantly available perfusion parameters and generally accepted predictors of posttransplant graft survival. In conclusion, NMP is feasible reliably for periods of at least 24 hours, even in highly suboptimal donor organs. Potential benefits include not only viability testing (as suggested in recent clinical implementations), but also removal of the time constraints associated with the utilization of high-risk livers, and recovery of ischemic and other preretrieval injuries (possibly by enabling therapeutic strategies during NMP). Liver Transplantation 23 207-220 2017 AASLD.
Department of General and Visceral Surgery, University Hospital Münster, Münster, Germany.
Thomas
T
Vogel
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Jens G
JG
Brockmann
Institute of Liver Studies, King's College London, London, UK.
Alberto
A
Quaglia
Department of Clinical Biochemistry, Oxford University Hospitals National Health Service Trust, Oxford, UK.
Alireza
A
Morovat
Institute of Liver Studies, King's College London, London, UK.
Wayel
W
Jassem
Institute of Liver Studies, King's College London, London, UK.
Nigel D
ND
Heaton
Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
Constantin C
CC
Coussios
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Peter J
PJ
Friend
D000328:Adult; D000368:Aged; D064591:Allografts / Q000473:pathology*; D050377:Cold Ischemia / Q000009:adverse effects; D046148:Donor Selection / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control; D013696:Temperature; D013997:Time Factors; D014019:Tissue Donors; D014022:Tissue Survival; D020858:Tissue and Organ Harvesting / Q000379:methods*; D052096:Warm Ischemia / Q000009:adverse effects