Two hours of end-ischemic oxygen persufflation of cold stored porcine livers regenerates cellular energy dependent pathways and improves survival after transplantation. The present trial evaluated oxygen persufflation as adjunct in clinical liver preservation.

Patients and Methods

Between 1/11 and 12/13 a total of n=116 adult patients (age: 54(23-68) years, M/F: 70/46), were enrolled in this prospective randomized study. Grafts were randomized to either retrograde O2-persufflation for ≥ 2 hours (O2) or mere cold storage (control). Only liver grafts from donors ≥55 years and/or grafts allocated as rescue offers were included. Primary endpoint was peak-AST level till post-op. day 3. Standard parameters including graft- and patient survival were evaluated as secondary endpoints. Data monitoring and analysis was performed by the local Clinical Trial Center.

Results

Both study groups were comparable except for a longer ICU stay (4 vs. 3 days) of the donors and a higher recipient age (57 vs. 52 years) in the O2-group. S-TNF-α and TNF gene expression in liver tissue 1h after reperfusion was reduced in the O2 group (p<0.05). Median peak-AST values did not differ between the groups (O2: 580 U/l, control: 699 U/l). 2 patients (1.7%) were re-transplanted for PNF/ hepatic artery thrombosis. Three month graft- and patient survival was similar (O2 vs. control: 87.9% vs. 91.5% and 89.5% vs. 91.5%, p=0.50). Substitution of coagulation factors, thrombocyte and/or erythrocyte concentrates and ICU-stay >8 days was increased in controls (p> 0.05). Following discharge 4.7% in the O2 group and 12.4% of the controls were treated for ITBL.

Conclusions

Apart from multiple tendencies in favor for pre-implantation O2-persufflation, this study failed to demonstrate a statistically significant superiority of O2-persufflation. However, due to the overall low incidence of PNF and the fuzzy definition of early allograft dysfunction the relevancy of this finding is unclear.

« Back to 2015 American Transplant Congress