Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death

Abstract

Correction made after online publication September 22, 2015: Author listing has been revised.Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57-year-old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life-supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma-free red cell-based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia.

Development of a normothermic extracorporeal liver perfusion system toward improving viability and function of human extended criteria donor livers

“…In many studies (including ours), despite an initial immediate increase in the glucose levels upon connecting the liver to the NELP system, a constant reduction of glucose has been reported. (28,36,46) In fact, it has been shown that a constant reduction in perfusate glucose concentrations during NELP is accompanied by increased glycogen storage in the hepatocytes. (47) On the other hand, glucose decline during NELP is a good sign of liver functionality and shows that the glucose is constantly being picked up by the hepatocytes and is being stored as glycogen.…”

Potential approaches to improve the outcomes of donation after cardiac death liver grafts

“…During the first 74 min of perfusion, the lactate was decreased from 7.2 to 0.3 mmol/L. after implantation the liver biochemistry was normal and during 6 mo posttransplant observation, there was no evidence of cholangiopathy [37] .…”

Perfusion device for liver preservation ex vivo before transplantation: first experimental study

“…Снижение уровня лактата до нормаль ных значений, адекватное производство желчи, а также сохранность структуры гепатоцитов и жел чевыводящих путей позволило сделать вывод, что НАП является эффективным способом улучше ния качества АСД печени. В недавнем сообщении Watson et al [15] также показали эффективность воздействия нормотермической перфузии на АСД печени перед пересадкой. Трансплантат печени был получен от 57 летнего донора.…”