We compared the novel normothermic acellular ex vivo liver perfusion (NEVLP) with conventional cold static organ preservation for livers retrieved after cardiac death.
Methods: Pig livers were either subjected to 1hr warm ischemia plus 12hrs cold storage in UW (n=5) or 1hr warm ischemia plus 4hr cold storage plus 8hr NEVLP. After 12hr organ preservation liver transplantation was performed. Liver injury and function was assessed by H&E staining, AST, and bile production. Hepatic energy content was determined by ATP and glycogen levels in biopsies taken before explantation, after warm ischemia and 8 hs after transplantation. Beta galactosidase and TNFΑ were evaluated as marker of Kupffer cell activation.
Results: NEVLP was associated with significantly decreased AST levels (768+547 U/L vs 1640+760 U/L, p<0.01) and less necrosis (10% vs 35%, p<0.05). Cold storage was associated with loss of peripheral arterial blood supply, while arterial blood flow was maintained in NEVLP preserved grafts. Cold stored grafts had massive biliary necrosis (90%), while bile ducts were normal in NEVLP preserved livers. Warm ischemia decreased ATP and glycogen content 10% each. The ATP levels in NEVLP grafts were re-established to baseline levels after transplantation, while glycogen content reached 30% of sham livers. During NEVLP beta-galactosidase activity increased fourfold (from 91ng/ml to 396 ng/ml), while TNFΑ levels tripled (from 401ng/ml to 1500ng/ml).
Conclusion: Acellular NEVLP decreases hepatocyte and bile duct injury in DCD grafts. High beta galactosidase activity and increasing TNF-alpha levels during NEVLP indicate an activation of Kupffer cells. Moreover hepatic glycogen content was decreased. Glycogen restorage and management of Kupffer cell derived inflammation need further investigations.
To cite this abstract in AMA style:Boehnert M, Knaak J, Adeyi O, Yip P, Selzner N, Levy G, Keshavjee S, Grant D, Selzner M. Normothermic Acellular Ex Vivo Liver Perfusion (NEVLP): Development of a New Method for the Storage, Assessment, and Repair of Marginal Liver Grafts [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/normothermic-acellular-ex-vivo-liver-perfusion-nevlp-development-of-a-new-method-for-the-storage-assessment-and-repair-of-marginal-liver-grafts/. Accessed May 16, 2021.
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