Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Ex-vivo machine perfusion of livers (MP) may offer superior preservation for marginal donor organs. During normothermic machine perfusion (NMP) is possible to assess liver viability before transplantation. A period of hypothermic machine perfusion (HMP) prior to NMP may promote restoration of liver metabolism. The aim of this study was to compare the achievement of viability criteria in human livers subjected to NMP alone or a combination of HMP followed by NMP; and, analyse factors associated with the positive outcome.
Methods: We analysed 46 discarded human livers submitted to MP including NMP alone for 6 hours or a combined protocol of HMP for 2 hours followed by NMP for further 4 hours. Viability was assessed at the end of the NMP in both groups using our established lactate clearance criteria. Histology and perfusate were sampled for analysis. Outcomes were analysed using Pearson's chi-squared, Mann–Whitney U test and logistic regression.
Results: Steatosis was the main for organ discard (46%). Overall 52% (n=24) of the perfused organs achieved viability criteria. From 29 livers that had NMP alone 12 (41%) met viability compared to 12 (71%) from the 17 livers submitted to the combined protocol of HMP+NMP (p=0.050). Non-viable livers presented with higher donor BMI (30[26-34] vs. 25[21-32] kg/m2, p=0.048), were discarded more often for steatosis (20[91%] vs. 11[45.8%], p=0.001) and presented higher liver weight (2208g[1889-2445] vs. 1795g[1629-2155], p=0.011). On multivariable analysis livers declined for steatosis (Odd ratio [OR]:50.6; 95% confidence interval [CI]:3.7-688.9; p=0.003), donor height (OR:1.1; 95%CI:1.1-1.2; p=0.039) and NMP alone (OR:10.3; 95%CI:1.5-70.9; p=0.018) were identified as independent risk factors for non-achievement of the viability criteria.
Conclusion: Combination of HMP and NMP can increase the rescue of very-high risk extended criteria donor livers. However steatosis remains the major risk factor for non-viability achievement. New strategies to improve those organs still needed.
CITATION INFORMATION: Boteon Y., Laing R., Schlegel A., Attard J., Wallace L., Smith A., Perera T., Isaac J., Mirza D., Afford S., Mergental H. Factors Predicting Viability Achievement on Discarded Donor Livers Submitted to Extra-Corporeal Machine Perfusion Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Boteon Y, Laing R, Schlegel A, Attard J, Wallace L, Smith A, Perera T, Isaac J, Mirza D, Afford S, Mergental H. Factors Predicting Viability Achievement on Discarded Donor Livers Submitted to Extra-Corporeal Machine Perfusion [abstract]. https://atcmeetingabstracts.com/abstract/factors-predicting-viability-achievement-on-discarded-donor-livers-submitted-to-extra-corporeal-machine-perfusion/. Accessed January 24, 2020.
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