Prediction of Hepatocellular Preservation Injury Immediately Before Human Liver Transplantation by Controlled Oxygenated Rewarming

T acceptance of livers of limited quality has been the predominant way to increase the donor pool in recent years. Unfortunately, this practice increases the risk afflicted with the procedure, because these organs are more prone to preservation induced injury and ultimately allograft damage and dysfunction. Accordingly, morbidity and mortality are increased in the context of marginal liver allografts, and the evaluation of potential allografts for suitability for transplantation at the end of the preservation period becomes pivotal. Traditional methods include gross inspection, liver histology, and analysis of donor risk factors and fail to give precise insights to the expectable allograft damage and dysfunction. Recently, we introduced the concept of controlled oxygenated rewarming (COR) by machine perfusion after cold storage at the end of the preservation period as a new tool for allograft reconditioning in human liver transplantation. This method uses pulsatile arterial and continuous portal perfusion of the allograft with oxygenated Custodiol-N solution (Dr. Köhler-Chemie, Bensheim, Germany). After initial hypothermic perfusion with 10°C, the temperature is gradually increased to 12°C, 16°C, and 20°C after 30, 45, and 60minutes, respectively. In total, perfusion is carried out for 90 to 120 minutes with a maximum perfusate temperature of 20°C. Here, we report our extended clinical experience in a larger numberof donororgans (mediandonor risk index, 2.0 [1.6-2.5]):