Introduction: NMP with sanguineous perfusate was reported to be effective in mitigating IRI of DCD livers. The roles of white blood cells, platelets, and inflammatory mediators in plasma are still unclear in the ex-vivo setting after prolonged warm ischemia (WI). The present study was to investigate the impact of NMP using various perfusates; whole blood (WB), Steen solution or Steen solution with washed red blood cells (RBCs), on the recovery and ischemia reperfusion injury (IRI) of DCD livers.

Materials and Methods: Livers from 20 pigs with 60 minutes of (WI) were divided into four groups and preserved for 10 hrs by; NMP-WB, NMP-Steen solution, NMP-Steen solution/RBCs and cold storage (CS). This was followed by 24 hrs of NMP with WB in an isolated perfusion system to simulate transplantation.

Results: After 24 hours of reperfusion, aspartate transaminase, alanine transaminase and alkaline phosphatase were significantly lower in the NMP-WB and NMP-Steen/RBCs groups compared to the CS (p<0.05). There was no significant difference between NMP-Steen and CS groups.

Bile production in all the NMP groups was significantly higher than CS group (p<0.01). Histologically, livers perfused by NMP showed preserved architecture in comparison to CS which showed abundant apoptosis and autolysis. Biliary epithelium was well preserved in the NMP-WB and Steen/RBCs groups. There was significant loss of biliary epithelium and peri-biliary glands in the CS and NMP-Steen groups.

Conclusion: NMP using WB and Steen/RBCs is superior to cold storage and NMP-Steen as a method of preservation of DCD livers. Biliary damage associated with bile production using acellular NMP could explain the primary functionality of DCD livers followed by delayed development of biliary strictures. Sufficient oxygenation during preservation could be the basis of prevention of biliary strictures in DCD livers.

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