Background. Normothermic ex vivo liver perfusion (NEVLP) is a novel method for graft-preservation applied alternatively to static cold storage (SCS). We examined the impact of NEVLP on platelet-aggregation and platelet-mediated SEC-injury.

Method. Pig liver transplantation (LT) was performed with heart-beating donor (HBD) and donation after circulatory death (DCD) livers (30min warm ischemia) subjected to 8hrs SCS (SCS-group) or NEVLP (NEVLP-group, n=5/group). Liver biopsies obtained 3hrs post-LT were stained for platelet-specific CD61. TGF-β and Platelet-specific MicroParticles (PMPs) were analysed. SEC-integrity was determined by CD31-staining and measurement of Hyaluronic Acid (HA). Liver enzymes, platelet-counts and other parameters were measured during 4 days survival.

Results. All pigs except for one (DCD-SCS-group) survived 4 days. The HBD- and DCD-NEVLP-groups showed significantly lower AST-levels on post-operative day (POD)1 and POD2 (p=0.046, p=0.033, respectively). Platelet-count recovery was earlier in the NEVLP- vs. SCS-groups 12hrs&24hrs after transplantation (% of baseline; p=0.009, p=0.005, respectively). Intrahepatic platelet-aggregation was significantly higher in the SCS-groups (# of clumps; HBD-groups:p=0.039 and DCD-groups:p=0.021, respectively). In both SCS-groups TGF-ß levels were significantly higher 3hrs post-LT, on POD1 and POD3 (p=0.013, p<0.001 and p=0.001, respectively). There was a trend towards higher increase of PMPs/platelet count from BL on POD1 in the SCS-groups vs. the NEVLP-groups (fold increase: HBD-livers=3.3±0.5 vs. 2.4±1.3, 30'DCD-livers=7.6±7.5 vs. 5.6±7.3). Platelet aggregation correlated with SEC injury, evaluated by scoring the CD31-staining (HBD-groups:p=0.018 and DCD-groups:p=0.004, respectively). Consistently, HA levels were significantly higher in SCS-groups vs. NEVLP-groups 3hrs&24hrs post-LT (p=0.007 and p=0.001, respectively).

Conclusion. Platelet aggregation and SEC injury post-reperfusion was prevented by NEVLP prior to LT. NEVLP allows a faster recovery of the platelet count after LT and might protect the liver from platelet-induced SEC injury.

CITATION INFORMATION: Kollmann D., Linares I., Ganesh S., Rosales R., Tessandier N., Boilard E., Hamar M., Urbanellis P., Yip P., Adeyi O., Selzner M., Selzner N. Normothermic Ex Vivo Liver Perfusion Prior to Liver Transplantation Can Prevent Platelet Aggregation and Platelet Induced Sinusoidal Cell Injury Am J Transplant. 2017;17 (suppl 3).

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