Introduction: Donor organ shortages have led to increased interest in finding new approaches to recover organs from extended criteria donors (ECD). Normothermic ex-vivo liver perfusion (NELP) has been proposed as a superior preservation method to reduce ischemia reperfusion injury (IRI), pre-condition sub-optimal grafts and treat ECD livers so that they can be successfully used for transplantation. The goal of this study was to investigate the efficacy of modified NELP to re-establish physiologic parameters and metabolic functions in discarded human livers that were rejected for transplantation. Methods: Seven human livers that were considered not-suitable for transplantation were put on the NELP system for eight hours. Blood samples were taken at hourly intervals and checked for blood gasses, markers of hepatic injury, oxygen extraction ratio, triglyceride (TG) and LDL (in case of steatotic livers). Biopsies were taken at the beginning and the end of the experiments. Results: NELP stabilized transaminases and in all ECD livers at the end of experiments: AST (1116±1363U/L) and (ALT: 1330±720U/L). This was accompanied by significant improvement in bile (4±2ml/hour) production and a remarkable decline in lactate (<0.05 mmol/L) and INR values (3.1±1.1). pH, Na⁺, K⁺, cl^–, pCO₂, bicarbonate and glucose levels were stabilized at physiologic levels. Oxygen extraction ratio was recovered (>0.8) in all livers during first 30 minutes of NELP and maintained until the end of study. NELP also, provided physiological vascular flows and pressures. Histology demonstrated normal parenchymal architecture and minimal to complete lack of IRI in all ECD livers. Figure 1 summarize some important data. Conclusion: The modified NELP circuit preserved hepatocyte architecture, recovered synthetic functions and hepatobiliary parameters of ECD grafts without additional injury to the graft. This approach has the potential to increase the donor pool for clinical transplantation.

CITATION INFORMATION: Banan B, Watson R, Xu M, Lin Y, Chapman W. Modified Normothermic Extracorporeal Liver Perfusion for Discarded Human Livers. Am J Transplant. 2016;16 (suppl 3).

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