Introduction: Hypothermic machine perfusion (HMP) is in its infancy in Liver Transplantation. We analyzed all molecular samples from our cumulative clinical experience at Columbia University.

Methods: Grafts preserved with HMP were compared to static cold stored (SCS) transplant controls. Both SCD and ECD grafts were included. All cases with tissue and serum available for molecular analysis were included. Thirty-five HMP cases were compared to 37 SCS cases. These groups were similar in age, demographics, transplant indication, MELD Score and Warm Ischemic Time. Expression of inflammatory cytokine (Interleukin-1 beta (IL-1β)), adhesion signaling molecule (Intracellular Adhesion Molecule 1 (ICAM-1)), and hypoxia marker (Hypoxia-inducible factor 1-alpha (HIF-1α)) were examined using RT-PCR on biopsy samples at donor visualization (D), post storage (S) and post reperfusion (R). M30/M65 ELISA serum assays (markers for aopoptosis and necrosis respectively) were also performed. Results: RT-PCR of post reperfusion biopsy (R) samples in the SCS group (white bars) showed significantly elevated expression of IL-1β, ICAM-1 and HIF-1α (Figure 1). This upregulation was significantly attenuated in livers that were preserved by HMP (black bars). Serum M30 and M65 markers both showed significant increases in SCS cases, whereas the increases HMP livers did not reach significance. (Figure 2). Conclusion: HMP's benefits work at the molecular level reducing the activation of preservation injury due to upstream cytokines, adhesion mediators and apoptotic signals as well improving the oxygen environment thereby reducing the overall reperfusion damage.

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