Introduction: Normothermic machine perfusion (NMP) represents a new preservation modality that could allow for better preservation of marginal donors such as donor after cardiac death (DCD). Few studies have investigated the role of on-pump arterial microcirculatory parameters as an indicator and predictor of graft function. Our aim was to investigate the relationship between intrahepatic arterial hemodynamics and organ function in a porcine DCD model of normothermic ex-vivo liver perfusion.

Methods: Ten porcine livers (n=5/group) exposed to 1 hour warm ischemia, were preserved for 10 hours by cold storage (CS) or NMP. Livers were then reperfused for 24 hours with whole blood in an isolated perfusion system to simulate transplantation. In our model, arterial and portal venous flows were adjusted to maintain physiologic pressures (pressure controlled system).

Results: While both CS and NMP-preserved livers showed comparable arterial resistance (HAR) in the first 8 hrs post reperfusion, CS livers showed increasingly high HAR and consequently lower HA flow during the simulation phase. Bile production was significantly steady in NMP livers whereas negligible in CS-preserved livers (218.2±37.1 vs 11.6±16.3 ml; p=0.0001). Post reperfusion HA/PV Flows, ALT, AST and ALKP are depicted in figure 1. Portal flow had no significant difference between groups at any time.

Conclusion: Arterial microcirculatory integrity is an important marker of graft damage and a key determinant of post transplant graft function. In our model, NMP proved to be superior to CS and a useful tool able to identify irreversibly damage grafts.

« Back to 2013 American Transplant Congress