Normothermic Oxygenated Machine Preservation Reduces Reperfusion Injury of DCD Livers but Seems Less Useful in Standard Heart-Beating Livers: A Comparative Study in a Rat Model
Surgical Research Laboratory, University Medical Center Groningen, Groningen, Netherlands
HPB Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands
Meeting: 2013 American Transplant Congress
Abstract number: D1657
Background: Normothermic oxygenated machine perfusion (NMP) may reduce ischemia/reperfusion (I/R) injury in livers derived from donation after cardiac death (DCD) donors. Aim of this study was to compare NMP with simple cold storage (SCS) of rat livers from DCD donors and from standard (non-DCD) donors.
Methods: Lewis rats were used as liver donors in all experiments. In the DCD group a time period of 30 min of cardiac arrest was induced before flush out with cold saline and hepatectomy. In the standard donor group, livers were immediately flushed and removed. Within the DCD group and the standard group, livers were preserved by either SCS in cold saline for 3h (n=6) or NMP for 3h (n=6). NMP consisted of oxygenated, pressure-controlled continuous perfusion via the portal vein and pulsatile perfusion via the hepatic artery using a red blood cell based perfusion fluid. After the 3h preservation all livers were reperfused ex vivo for 2h using the same dual perfusion system and perfusion fluid as used for NMP. Samples were taken from the perfusion fluid for biochemical analysis and biopsies were taken from livers and bile ducts for histology en electron microscopy (EM).
Results: The increase in biochemical markers of hepatic injury, ALT, AST and LDH, in the perfusion fluid was significantly greater at 1h after reperfusion of DCD livers that were preserved by SCS, compared with NMP (p<0.05). In the group of standard livers there were no significant differences in increase of AST and LDH between the NMP and SCS subgroups. When comparing DCD livers that were preserved with NMP with standard livers preserved by SCS, there were no significant differences in AST and ALT. In parallel with this, histology of liver parenchyma and EM of bile ducts showed a beneficial effect of NMP in the group of DCD livers.
Conclusion: Oxygenated NMP of livers from DCD donors results in a significant reduction of I/R injury compared with SCS. The positive effect of NMP is much less pronounced in standard livers from heart beating (non-DCD) donors. NMP is a promising new tool that may help reduce the amount of I/R injury in DCD livers to a level similar to what is seen after SCS of standard (non-DCD) livers.
To cite this abstract in AMA style:
Dries Sopden, Karimian N, Sutton M, Kuipers M, Leuvenink H, Lisman T, Porte R. Normothermic Oxygenated Machine Preservation Reduces Reperfusion Injury of DCD Livers but Seems Less Useful in Standard Heart-Beating Livers: A Comparative Study in a Rat Model [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/normothermic-oxygenated-machine-preservation-reduces-reperfusion-injury-of-dcd-livers-but-seems-less-useful-in-standard-heart-beating-livers-a-comparative-study-in-a-rat-model/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress