Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
BACKGROUND&AIMS: Fatty liver diseases have led to a continuous increase of available donor livers containing fat. Fatty liver grafts were identified as an independent risk factor for graft failure. Ischemia and reperfusion injury (IRI) and cold storage (CS) were known to be inevitable events and closely related to downsides of fatty donor liver. Herein we tested ischemia-free liver transplantation (IFLT) to identify its advantage in using fatty donor livers.
METHODS: In this series, livers were retrieved, preserved and implanted under continuous normothermic machine perfusion (NMP), which enabled avoidance of IRI and CS. Viability was assessed with reference to biochemical changes in the perfusate and bile production. IFLT livers were matched 1:3 to conventional liver transplantation (CLT) livers. The early reperfusion injury and early transplant outcomes were compared between two groups.
RESULTS: Stable perfusion flow, low lactate, liverenzyme levels, and continuous bile production were observed during NMP in IFLT. Early allograft dysfunction was significantly lower (0% IFLT vs 77.8% CLT, p<0.001). Median peak aspartate aminotransferase within the first 7 days was significantly lower in IFLT (578.5, 166.0-1217.0 IU) versus CLT (3581.5, 1581.0-14713 IU, p=0.001). Peak alanine aminotransferase and total bilirubin in the first 7 days were also significantly lower in IFLT
|Outcomes||IFLT (3)||CLT (9)||p-value|
|EAD, n (%)||0||7 (77.8)||0.001|
|Peak AST within 7 days (IU/L), median (range)||278.5 (166.0-479.0)||3581.5 (1581.0-14713)||0.001|
|Peak ALT within 7 days (IU/L), median (range)||134.5 (103.0-221.0)||752.5 (198.0-3009)||0.002|
|Tbil on day 7 ([mu]mol/L), median (range)||18.2 (13.8-59.7)||86.0 (16.0-392.9)||0.119|
|ALP on day 7 (IU/L), median (range)||141.0 (80-312)||145.5 (77-441)||0.721|
|GGT on day 7 (IU/L), median (range)||169.0 (53-698)||263.0 (100-498)||0.673|
|INR on day 1||1.44 (1.27-1.54)||1.42(1.13-2.16)||0.820|
. Histological study revealed minimal hepatocyte and biliary epithelium during preservation and post-transplantation. The inflammatory cytokine levels were much lower in IFLT.
CONCLUSIONS: This study demonstrates the safety, feasibility and superiority of IFLT applying in fatty liver. IFLT could be used globally to expand the donor pool.
CITATION INFORMATION: Ju W., Huang S., Guo Z., Chen G., He X. Ischemia-Free Liver Transplantation for Fatty Liver Grafts in Human Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Ju W, Huang S, Guo Z, Chen G, He X. Ischemia-Free Liver Transplantation for Fatty Liver Grafts in Human [abstract]. https://atcmeetingabstracts.com/abstract/ischemia-free-liver-transplantation-for-fatty-liver-grafts-in-human/. Accessed April 21, 2019.
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