BACKGROUND&AIMS: In organ transplantation, ischemia and reperfusion injury (IRI) is considered as an inevitable event and the major contributor of graft failure. Great efforts have been made for ameliorating or treating IRI in organ transplantation, although no breakthrough has been achieved. We aimed to test whether IRI can be prevented if initial ischemia of grafts is avoided.

METHODS: With surgical innovations and normothermic machine perfusion (NMP), a novel transplant procedure called ischemia-free liver transplantation (IFLT) was established. Ten pigs were subjected to IFLT or conventional liver transplantation (CLT). Donor livers in IFLT underwent 6-hour continuous NMP throughout graft procurement, preservation and implantation, while livers in CLT were subjected to 6-hour cold storage before implantation. The early reperfusion injury was compared between the two groups.

RESULTS: Continuous bile production, low lactate and liver enzyme levels were observed during NMP in IFLT. All animals survived after liver transplantation. The post-transplant graft function was much better in IFLT when compared to CLT. Minimal histological changes, fewer apoptotic hepatocytes, less sinusoidal endothelial cell injury and pro-inflammatory cytokine (IL-1β, IL-6 and TNF-α) release after graft re-vascularization were documented in IFLT group when compared to CLT group.

CONCLUSIONS: For the first time, we prove that IFLT is feasible in pigs. By using IFLT, IRI is largely avoided. This innovation provides a potential strategy to achieve optimal organ utilization and transplant outcomes for clinical practice.

CITATION INFORMATION: Guo Z., He X., Tang Y., Ji F., Zhang Z., Zhao Q., Huang S., Zhu Z., Ju W., Chen G. Ischemia-Free Liver Transplantation in Pigs: Ischemia Reperfusion Injury is Avoidable? Am J Transplant. 2017;17 (suppl 3).

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