Resuscitation and Viability Testing of Initially Declined Livers Using Sequential Hypo- and Normothermic Machine Perfusion with an Acellular Fluid
1Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
2Section of HPB Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands
3Department of Critical Care, University Medical Center Groningen, Groningen, Netherlands
4Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
5Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands.
Meeting: 2018 American Transplant Congress
Abstract number: 203
Keywords: Liver preservation, Liver transplantation, Perfusion solutions, Preservation
Session Information
Session Name: Concurrent Session: Ischemia Reperfusion Injury: Time to Change the Paradigm?
Session Type: Concurrent Session
Date: Monday, June 4, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Room 6B
While end-ischemic dual hypothermic oxygenated machine perfusion (DHOPE) resuscitates mitochondria and reduces ischemia-reperfusion injury, normothermic machine perfusion (NMP) allows for ex-situ functional testing of donor livers. We established a combined protocol of one hour DHOPE, followed by controlled oxygenated rewarming (COR), and NMP for resuscitation and functional testing of high risk donor livers that were initially declined for transplantation nation-wide, with the purpose to expand the donor pool.
From July until October 2017, three livers were included. To facilitate machine perfusion at different temperatures an acellular perfusion fluid containing an hemoglobin-based oxygen carrier (HBOC) was developed. Livers were deemed transplantable if bile production was ≥ 10 g, biliary pH >7.45, and perfusate pH and lactate levels normalized within the first 150 min of NMP.
Median cumulative bile production was 57 g at 150 min of NMP. Liver 1 reached normal perfusate pH and lactate levels, as well as a biliary pH of 7.55 within 150 min of NMP. Perfusate peak ALT was 540 IU/L. This liver was transplanted, with the recipient in excellent condition at 3 months of follow-up. Liver 2 reached normal perfusate pH and lactate levels within 150 min of NMP, but biliary pH was 7.39. Perfusate peak ALT was 4215 IU/L. Liver 3 did not reach normal perfusate pH and lactate levels within 150 min of NMP. Moreover, biliary pH was 7.32 and perfusate Peak ALT 8460 IU/L. Livers 2 and 3 did not meet the viability criteria and were therefore discarded.
Sequential DHOPE, COR and NMP, using an acellular fluid containing an HBOC, is feasible and enables both resuscitation and viability testing of high risk donor livers prior to transplantation. This protocol provides a tool to expand the donor pool by selecting initially declined donor livers that can be transplanted.
CITATION INFORMATION: de Vries Y., Matton A., Karangwa S., Nijsten M., de Kleine R., van den Berg A., de Meijer V., Meyer P., de Boer M., Porte R. Resuscitation and Viability Testing of Initially Declined Livers Using Sequential Hypo- and Normothermic Machine Perfusion with an Acellular Fluid Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Vries Yde, Matton A, Karangwa S, Nijsten M, Kleine Rde, Berg Avanden, Meijer Vde, Meyer P, Boer Mde, Porte R. Resuscitation and Viability Testing of Initially Declined Livers Using Sequential Hypo- and Normothermic Machine Perfusion with an Acellular Fluid [abstract]. https://atcmeetingabstracts.com/abstract/resuscitation-and-viability-testing-of-initially-declined-livers-using-sequential-hypo-and-normothermic-machine-perfusion-with-an-acellular-fluid/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress