"In-House" Controlled Oxygenated Rewarming After Initial Static Cold Storage: First Clinical Application in Marginal Donor Livers
1General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
2Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
3Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
4Surgical Research Division, University Hospital Bonn, Bonn, Germany.
Meeting: 2015 American Transplant Congress
Abstract number: 503
Keywords: Donors, Graft acceptance, Liver preservation, marginal
Session Information
Session Name: Concurrent Session: Strategies To Minimize Ischemia Reperfusion Injury
Session Type: Concurrent Session
Date: Tuesday, May 5, 2015
Session Time: 4:00pm-5:30pm
Presentation Time: 4:00pm-4:12pm
Location: Room 119-B
Introduction
Controlled oxygenated rewarming of cold stored livers by machine perfusion demonstrated a strong protective effect in preclinical studies. Here we report on the first clinical application of this new concept in a pilot series of 6 marginal donor grafts.
Methods
Between 03/2014 and 05/2014 six distally procured livers from DBD-donors, which had been rejected by other transplant centers were subjected to the controlled rewarming protocol before transplantation. Immediately after arrival in our transplant center the hepatic artery and portal vein were cannulated. Gentle rewarming of the graft was effectuated thereafter by pressure controlled oxygenated machine perfusion (MP) via portal vein and hepatic artery (Organ Assist, Groningen, NL) while gradually increasing perfusate temperature up to 20°C. Custodiol-N was used as preservation solution. Real-time biochemical analysis of perfusate parameters was carried out in constant time intervals during the controlled rewarming.
Results
Donor age was 58.5 (51-71) years, cold ischemic times were 8.5 (6.2-14.5) hours and the donor risk index was 2.1 (1.5-2.5). All recipients were male with a median age of 52.5 (43-65) years and a labMELD before transplantation of 18 (11-23). All patients experienced good primary function with mean peak aminotransferase (AST) levels within the first 7 days of 563.5 (305-1524) U/l. No correction of coagulation dysfunction was necessary in any recipient. A significant correlation (r2=0.78; p<0.02) was seen for the change in glucose concentrations of the perfusate during the subnormothermic perfusion period with higher glucose release in livers with subsequently inferior function. Three month after transplantation, all recipients are alive with excellent graft function.
Conclusions
The first in man applications of controlled oxygenated graft rewarming via machine perfusion prior to transplantation showed excellent immediate graft function in all patients. Alleviation of preservation/ rewarming injury in combination with subnormothermic machine perfusion seems to be a promising new tool to decrease discard rates of marginal livers.
To cite this abstract in AMA style:
Hoyer D, Mathé Z, Gallinat A, Canbay A, Treckmann J, Rauen U, Paul A, Minor T. "In-House" Controlled Oxygenated Rewarming After Initial Static Cold Storage: First Clinical Application in Marginal Donor Livers [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/in-house-controlled-oxygenated-rewarming-after-initial-static-cold-storage-first-clinical-application-in-marginal-donor-livers/. Accessed June 1, 2025.« Back to 2015 American Transplant Congress