Extreme Hyperoxia During Pre-Implant Normothermic Liver Perfusion (PINLiP) Is Associated with Post-Reperfusion Syndrome and Vasoplegia.
Cambridge Transplant Unit, Addenbrookes Hospital, Cambridge, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: B242
Keywords: Donors, Liver preservation, Machine preservation, non-heart-beating
Session Information
Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
In response to the increasing number of DCD and marginal DBD donor livers, we started a programme of pre-implant normothermic perfusion (PINLiP) to enable functional assessment of livers before transplantation.
We used the Liver Assist (Groningen) device to perfuse livers from the time of arrival in our unit until implantation. The leukocyte-depleted erythrocyte-based perfusate was oxygenated with an air/CO2/O2 mixture at 37[deg]C. Transaminase release and the ability of the liver to clear lactate, reverse post reperfusion hyperglycaemia, maintain pH and produce bile were assessed. Post reperfusion syndrome was defined as a post reperfusion MAP<70% baseline for ≥1 minute within 5 mins of reperfusion (Aggarwal et al, 1993). Vasoplegia was defined as the need for more than one of norepinephrine, epinephrine, and/or vasopressin for sustained hypotension in the first 30 minutes post reperfusion.
8 livers (7 DCD, 1 steatotic DBD) were subjected to PINLiP. The first 6 had mean perfusate oxygen (O2) levels of 79 – 90kPa during perfusions which lasted between 132 and 491 minutes; the last two livers were managed with perfusate O2 levels 21-24kPa, with target mixed "venous" O2 saturations of 70%.
There was no significant fall in MAP following reperfusion of the two livers maintained with lower perfusate O2. In contrast, 5 of the 6 livers subject to perfusate extreme hyperoxia developed post reperfusion syndrome, and 4 of these had ≥30mins of vasoplegia. Only the liver with the shortest period of PINLiP and the two livers with the low PaO2 did not cause post reperfusion instability
| Liver donor | Time from asystole to PINLiP (mins) | Duration of PINLiP (mins) | Mean perfusate pO2 (kPa (mmHg)) | Post reperfusion syndrome | Vasoplegia |
| 57y DCD | 360 | 132 | 83 (621) | – | – |
| 23y DCD | 419 | 321 | 88 (659) | – | + |
| 62y DCD | 222 | 272 | 86 (647) | + | + |
| 56y DCD | 346 | 262 | 79 (596) | + | + |
| 45y DCD | 445 | 261 | 85 (641) | + | + |
| 48y DCD | 438 | 491 | 90 (673) | + | + |
| 54y DCD | 396 | 295 | 21 (154) | – | – |
| 60y steatotic DBD | 608 | 459 | 24 (176) | – | – |
.
Extreme perfusate hyperoxia is reported in hypothermic liver perfusion and short periods of normothermic kidney perfusion. Our experience suggests hyperoxia for prolonged periods of normothermic liver perfusion is associated with post reperfusion syndrome and sustained vasoplegia, and should be avoided. We are currently studying the mechanism underlying these observations.
CITATION INFORMATION: Watson C, Kosmoliaptsis V, Randle L, Hamed M, Klinck J, Butler A. Extreme Hyperoxia During Pre-Implant Normothermic Liver Perfusion (PINLiP) Is Associated with Post-Reperfusion Syndrome and Vasoplegia. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Watson C, Kosmoliaptsis V, Randle L, Hamed M, Klinck J, Butler A. Extreme Hyperoxia During Pre-Implant Normothermic Liver Perfusion (PINLiP) Is Associated with Post-Reperfusion Syndrome and Vasoplegia. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/extreme-hyperoxia-during-pre-implant-normothermic-liver-perfusion-pinlip-is-associated-with-post-reperfusion-syndrome-and-vasoplegia/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress