Normothermic machine perfusion of the liver (NMP-L) is a novel technique that preserves liver grafts in an environment that mimics physiological conditions and therefore enables normal metabolic activity. This process requires an adequate oxygen supply, which is typically delivered by packed red blood cells (RBC) in the perfusate. We present the first experience using an acellular hemoglobin-based oxygen carrier (HBOC) Hemopure in a human model of NMP-L.

Five high-risk human livers were discarded for clinical use and subsequently perfused with a HBOC-based perfusion fluid and matched to 5 RBC-perfused livers. Perfusion parameters, oxygen extraction, metabolic activity and histological features were compared over during a 6-hour period of NMP-L. The cytotoxicity of Hemopure was also tested on human hepatic primary cell line cultures using an in vitro model of ischemia reperfusion. Reactive oxygen species (ROS) production, apoptosis and necrosis were determined using an established three-color assay.

The vascular flow parameters and the perfusate lactate clearance were similar in both groups. The livers perfused with HBOC extracted more oxygen than those perfused with RBCs (O₂ER 13.75 vs 9.43 % x10⁵ per gram of tissue, p=0.001). There was no evidence of histological damage caused by Hemopure and histological features were comparable between groups. In vitro exposure to Hemopure did not alter intracellular levels of reactive oxygen species and there was no increase in apoptosis or necrosis observed in any of the tested cell lines. Hemopure can be used as a safe alternative oxygen carrier to packed red cells in NMP-L perfusion fluid.

CITATION INFORMATION: Boteon Y, Laing R, Bogal R, Neil D, Smith A, Stephenson B, Schlegel A, Hübscher S, Mirza D, Afford S, Mergental H. The Use of an Haemoglobin Based Oxygen Carrier in a Human Liver Model of Normothermic Machine Perfusion. Am J Transplant. 2017;17 (suppl 3).

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