Background: Low ATP contents in the graft have been associated with poor transplant outcomes. DCD grafts are particularly vulnerable to ischemia reperfusion injury because of additional warm ischemia. Thus, we hypothesize that adding an oxygen carrier – perfluorocarbon (PFC) to the preservation solution may reduce graft damage and improve outcomes of DCD grafts. Methods: Using a mouse model we simulated the ischemic damage of a DCD liver. Livers from C57/B6 mice were exposed to warm ischemia (37°C) for 45min, followed by flushing and storage in either pre-oxygenated UW solution or pre-oxygenated PFC+ UW solution (PFC at 20%). ATP from liver tissue was measured at different time points by luminescence assay and corrected for protein by the Bradford method. In another experiment, we transplanted syngeneic rat livers after a warm ischemia period of 45min + 4h of cold ischemia in either UW solution of PFC+UW. Both solutions were pre-oxygenated for 30min. Survival was compared using log-rank test. Results: PFC increased ATP levels above pre-ischemic levels and delayed the drop of ATP during cold preservation over a period of 24h (fig.1). This was associated with less histopatological changes in hepatocytes and biliary epithelium. In addition, PFC improved survival of rat DCD liver grafts (p=0.025), even leading to long-term survival while control animals died within 24h (fig.2). Experiment still ongoing. Conclusions: Adding oxygen carriers is a promising approach to improve results of static cold preservation of DCD liver grafts.

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