Adenine nucleotide liver tissue concentrations from non-heart-beating donor pigs and organ viability after liver transplantation

Superior Preservation of DCD Livers With Continuous Normothermic Perfusion

“…[6][7][8] NECMO initiates the processes of energy repletion and cellular repair, whereas subsequent NMP provides the physiological conditions and substrates necessary for continued graft improvement during ex vivo preservation. 16,17 Essentially, there is no typical reperfusion injury when a graft preserved with NMP is "reperfused" in the recipient.…”

“…The choice to use NECMO and not hypothermic recirculation is based on experimental studies performed at our center, which have shown that the recirculation of oxygenated blood at 37 • C, unlike total body cooling, improves the cellular energy load, reduce tissue injury, and improve posttransplant graft function in livers damaged by the period of warm ischemia caused by cardiac arrest. [6][7][8] In 2007, our group described the first 10 human liver transplant recipients who received a DCD liver procured according to this protocol. 9 As of this writing, more than 30 such transplants have been performed.…”

Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors

“…Since cell metabolism decreases rapidly at temperatures below 37 "C, Schon et al, in an experimental study with ex-vivo perfused pig livers, postulate that normothermic oxygenated perfusion after extraction could offer the possibility of restoring metabolic processes and repairing damaged cells, thus resuscitating ischemically injured livers [47]. Some other experimental studies in liver and kidney transplantation have demonstrated the utility of normothermic recirculation to recover adenine nucleotide levels after warm ischemia [4,21,25,401, to increase reduced glutathione levels in both the liver and the kidney before cold storage [4] and to improve post transplant viability [19,25,511. In this way, Rijkmans et a1 state that it is possible to prevent irreversible damage through normothermic blood perfusion [43].…”

Can we prevent ischemic‐type biliary lesions in donation after circulatory determination of death liver transplantation?

“…In DCD donors, abdominal regional perfusion is a preservation maneuver that may be applied following the declaration of death to limit ischemia and restore cellular energy substrates prior to CS. (46) The abdominal circulation isolated from the systemic circulation, and an in-line pump is used to recover donor venous blood, oxygenate it, and then return it to the subdiaphragmatic aorta. (47) Abdominal regional perfusion may be performed at either hypothermic (hypothermic regional perfusion [HRP]) or normothermic (NRP) temperatures.…”