Hemodynamic, biochemical, and morphological characteristics during preservation of normal porcine livers by hypothermic machine perfusion.

In renal transplantation, hypothermic machine perfusion optimizes preservation of marginal grafts, assesses their quality prior to transplantation, improves outcome, and may contribute to an increased number of transplantations. Recently, hypothermic machine perfusion has become increasingly popular given the organ shortage and the "obligatory" utilization of marginal organs. Increasing mortality on the liver transplantation waiting list makes it urgent to develop machine perfusion systems for livers, trying to better preserve marginal livers and perhaps to recover currently discarded livers are for clinical transplantation without an increased risk of graft nonfunction. However, data on machine perfusion of livers and perfusion parameters capable of predicting viability are scarce. The aim of this study was to determine the baseline hemodynamic and metabolic profiles and morphology of livers during hypothermic machine perfusion in a porcine model. We used protocol similar to hypothermic machine perfusion of kidneys. Hemodynamic analysis revealed higher vascular resistance in the hepatic artery versus the portal vein. The arterial resistance gradually decreased during perfusion (similar to kidneys), suggesting progressive relaxation of the arterial vasculature, and perhaps better penetration of the microcirculation by the perfusion solution. During hypothermic machine perfusion, transaminases were gradually (but modestly) released, and livers displayed unequivocal signs of aerobic and anaerobic metabolism. After 24 hours, livers appeared morphologically well preserved. In conclusion, this study showed that hypothermic machine perfusion was feasible. During hypothermic machine perfusion, was easily assessed hemodynamic, biochemical, and morphological parameters.

[1]  J. Chilcott,et al.  Pulsatile machine perfusion vs. cold storage of kidneys for transplantation: a rapid and systematic review , 2003, Clinical transplantation.

[2]  M. Pelsers,et al.  Comparison of perfusate activities of glutathione S-transferase, alanine aminopeptidase and fatty acid binding protein in the assessment of non-heart-beating donor kidneys , 2003, Annals of clinical biochemistry.

[3]  T. V. van Gulik,et al.  Improved rat liver preservation by hypothermic continuous machine perfusion using polysol, a new, enriched preservation solution , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[4]  K. Miller.  St. Peter's , 2007 .

[5]  R. Ploeg,et al.  PRESERVATION OF DOG LIVER, KIDNEY, AND PANCREAS USING THE BELZER‐UW SOLUTION WITH A HIGH‐SODIUM AND LOW‐POTASSIUM CONTENT1 , 1989, Transplantation.

[6]  M. Nicholson,et al.  Intra-renal resistance reflects warm ischaemic damage, and is further increased by static cold storage: a model of non-heart-beating donor kidneys. , 2003, Medical Science Monitor.

[7]  P. Friend,et al.  Liver and kidney preservation by perfusion , 2002, The Lancet.

[8]  T. Roskams,et al.  Livers from Non–Heart-Beating Donors Tolerate Short Periods of Warm Ischemia , 2005, Transplantation.

[9]  P. Friend,et al.  Optimisation of Bile Production during Normothermic Preservation of Porcine Livers , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[10]  P. Olinga,et al.  Oxygenation during hypothermic rat liver preservation: An in vitro slice study to demonstrate beneficial or toxic oxygenation effects , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[11]  T. Roskams,et al.  Does ex vivo vascular resistance reflect viability of non-heart-beating donor livers? , 2005, Transplantation proceedings.

[12]  G. J. Verkerke,et al.  Hypothermic machine perfusion of the liver and the critical balance between perfusion pressures and endothelial injury. , 2005, Transplantation proceedings.