Ex-situ machine perfusion (MP) is a promising method to improve organ viability prior to transplantation and is being used in various clinical trials worldwide. However, the heterogeneity of deceased donor livers makes it difficult to compare the results of ex-situ MP to conventional static cold storage (SCS), both in pre-clinical research using discarded human livers. We therefore developed a split liver ex-situ MP technique to provide matched controls for each liver.

We adapted our previously designed subnotmothermic (21[deg]C) MP protocol for whole liver grafts, to test whether two lobes of the same liver would be comparable to each other and to a whole graft during perfusion. Eleven discarded human livers with research consent were included. Livers were split anatomically into right and left lobes. Each lobe was perfused separately for 3 hrs.

As with whole liver perfusions, each lobe exhibited decreasing portal venous and hepatic arterial resistance and lactate levels,similarly to each other. Overall bile and ATP production was low in the split livers compared to whole liver perfusions. ALT release per gram of liver weight were slightly higher in left lobes compared to right lobes but didn't reach statistical significance.

Single liver lobes behave similarly to whole livers during MP, and more importantly, to each other. Split liver perfusion is a novel approach that may allow direct comparison of different preservation techniques and treatments on the same liver, circumventing the need for extremely large numbers of experimental and control livers necessary with the wide variability of discarded human livers. Optimizing perfusion techniques using this system may eventually increase the supply of viable donor organs so that fewer need to be discarded.

Figure 1: Single liver lobes behave similarly to each other during MP as shown by vascular resistance (A), ALT release (B) and Lactate release (C).

CITATION INFORMATION: Karimian N, Huang V, Geerts S, Mert S, Beijert I, Fontan F, Aburawi M, Porte R, Uygun K, Markmann J, Yeh H. Split Liver Ex-situ Oxygenated Machine Perfusion: A Novel Approach to Organ Preservation and Treatment. Am J Transplant. 2017;17 (suppl 3).

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