Hypothermic Machine Perfusion Versus Cold Storage in the Rescuing of Livers From Non‐Heart‐Beating Donor Rats

Abstract

The aim of this work was to compare the efficiency of cold storage (CS) and hypothermic machine perfusion (HMP) methods of preserving grafts excised from non-heart-beating donors that had suffered 45 minutes of warm ischemia. We developed a new solution for HMP to use in liver transplantation, based on BES, gluconate, and polyethylene glycol (BGP-HMP solution). After 24 h of HMP or CS, livers were reperfused at 37°C with Krebs-Henseleit solution with added dextran. For both procedures, portal pressure and flow were measured and the intrahepatic resistance (IR) was calculated. The pH oscillations and enzyme activities (LDH, AST, and ALT) were evaluated for the perfusion buffer during normothermic reperfusion. O2 consumption of the liver, glycogen production, and bile flow were also measured during the normothermic reperfusion period. Portal flow and IR showed statistical differences (P < 0.05) between the two groups (n = 5). HMP with BGP-HMP solution resulted in higher values of portal flow and lower IR than CS with HTK solution. Enzyme release after 90 min of reperfusion did not show statistical differences between groups. With regard to bile flow and O2 consumption, livers preserved by both processes were able to produce bile, but livers preserved with HMP were able to take up more O2 than livers preserved by CS.

Hypothermic oxygenated perfusion (HOPE) attenuates ischemia/reperfusion injury in the liver through inhibition of the TXNIP/NLRP3 inflammasome pathway in a rat model of donation after cardiac death

“…After retrieving livers, livers in HOPE group were connected to the precooled perfusion device and perfused via the portal vein. Perfusion flow was maintained at 0.23 ml/min per gram (38). Perfusate was not actively oxygenated (39,40) and recirculated for 3 h (perfusate volume 100 ml).…”

The Novel N,N‐bis‐2‐Hydroxyethyl‐2‐Aminoethanesulfonic Acid–Gluconate–Polyethylene Glycol–Hypothermic Machine Perfusion Solution Improves Static Cold Storage and Reduces Ischemia/Reperfusion Injury in Rat Liver Transplant

“…Here, we aim to develop a new preservation solution capable of being used in all the abdominal organs as well as for static and dynamic preservation techniques. In a previous work, we evaluated our new BGP‐HMP solution using HMP to rescue rat livers from non–heart‐beating donors (NHBDs) and proved that this solution used only for preservation might lead to a lower degree of injury than the one observed after using HTK for SCS . In the present work, we compared our BGP‐HMP solution with HTK by using SCS, IPRL, and heterotopic reduced nonarterialized auxiliary rat liver transplantation.…”

“…The maintenance and recovery of metabolism after preservation is another important point to analyze. In our previous work, using the BGP‐HMP solution with HMP, we found that the production of bile was diminished in relation to the SCS group with HTK in livers obtained from NHBDs . In this work, we confirmed a comparable decrease in the amount of bile secretion/production in livers preserved with both solutions, suggesting that the injury produced at the hepatocyte/canalicular level was similar with both solutions.…”

“…The composition of the HTK solution was described previously . The BGP‐HMP is an extracellular‐like preservation solution that was prepared in our laboratory, as previously described . The HTK solution and the BGP‐HMP solution were saturated with 600 mL/minute air flow at room temperature.…”

“…We developed an HMP solution based on N , N ‐bis‐2‐hydroxyethyl‐2‐aminoethanesulfonic acid–gluconate–polyethylene glycol (BGP). This solution was previously studied storing rats' livers by HMP, assayed in the in vitro model of isolated perfused rat livers (IPRLs), and its efficiency was compared with the HTK solution . IPRL offers different advantages in resembling in vivo conditions and standardized experimental setups, but nevertheless, it fails to fully translate all of the clinically relevant parameters.…”