Date: Saturday, June 1, 2019
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: The VITTAL (viability testing and transplantation of marginal livers) clinical trial demonstrated that ex situ end-ischaemic normothermic machine perfusion (NMP) allows functional assessment and transplantation of a large proportion of currently unutilised high-risk donor livers. This study aims to assess whether achievement of the VITTAL criteria for transplantability during NMP correlates with hepatobiliary injury and post-transplant outcomes.
*Methods: The transplantability of discarded high-risk donor livers was assessed during 4 hours of NMP using predefined viability criteria, consisting of: perfusate lactate levels ≤2.5mmol/L, presence of bile production, perfusate pH >7.30, metabolism of glucose, stable vascular arterial flow ≥150mL/min and portal vein flow ≥500mL/min. The livers were supplied with taurocholic acid and the perfusion performed on the OrganOx Metra® device. Perfusate transaminases, bile production and bile properties were assessed and correlated with post-operative clinical complications including ischemic-type biliary lesions (ITBL), early-allograft dysfunction (EAD) and post-reperfusion syndrome (PRS).
*Results: Twenty-two out of thirty-one (71%) livers meet the criteria and were transplanted. Livers deemed non-transplantable during NMP exhibits higher release of transaminases in the perfusate, suggesting more severe hepatobiliary injury (peak ALT -median[Interquartile range]- 9,667[4,600-20,505]vs. 2,410[1,130-4,832]IU/L, p<0.001; peak AST 14,033[5,902-28,436]vs. 4,760[2,316-6,533]IU/L, p=0.001; peak GGT 142[66-527]vs. 118[82-174]IU/L, p=0.051). Although the perfusate transaminase levels do not distinguish cases of PRS, EAD or ITBL post-transplantation, the peak ALT correlates with the recipients’ peak ALT ([Spearman’s]r=0.445, p=0.063). Eight patients (36%) developed ITBL on imaging within 180-days post-transplantation. Whilst bile production does not correlate with ITBL, bile pH <7.85 differentiates patients that developed ITBL (AUROC=0.836[95%CI:0.568->0.999], Sensitivity=91%, Specificity=80%, p=0.036).
*Conclusions: Viability assessment of high-risk donor livers during NMP using the VITTAL criteria might prevent transplantation of organs with severe hepatobiliary damage. Perfusate transaminases do not correlate with post-transplant complications. In the context of NMP with taurocholic acid supplementation, the bile pH cut-off of 7.85 may differentiates livers that develop ITBL following transplantation.
To cite this abstract in AMA style:Boteon YL, Laing R, Attard J, Wallace L, Smith A, Perera M, Mirza D, Mergental H, Afford S. Effectiveness Of The Vittal Viability Criteria During Ex Situ Normothermic Machine Perfusion To Discriminate Hepatobiliary Organ Injury And Investigation Of Biochemical Markers For Post-transplant Complications [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/effectiveness-of-the-vittal-viability-criteria-during-ex-situ-normothermic-machine-perfusion-to-discriminate-hepatobiliary-organ-injury-and-investigation-of-biochemical-markers-for-post-transplant-com/. Accessed April 15, 2021.
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