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Oxygenated Hypothermic Machine Perfusion After Static Cold Storage Improves Hepatobiliary Function of Extended Criteria Donor Livers.
- Source :
-
Transplantation [Transplantation] 2016 Apr; Vol. 100 (4), pp. 825-35. - Publication Year :
- 2016
-
Abstract
- Background: The mechanism through which oxygenated hypothermic machine perfusion (HMP) improves viability of human extended criteria donor (ECD) livers is not well known. Aim of this study was to examine the benefits of oxygenated HMP after static cold storage (SCS).<br />Methods: Eighteen ECD livers that were declined for transplantation underwent ex situ viability testing using normothermic (37 °C) machine perfusion (NMP) after traditional SCS (0 °C-4 °C) for 7 to 9 hours. In the intervention group (n = 6), livers underwent 2 hours of oxygenated HMP (at 12 °C) after SCS and before NMP. Twelve control livers underwent NMP without oxygenated HMP after SCS.<br />Results: During HMP, hepatic ATP content increased greater than 15-fold, and levels remained significantly higher during the first 4 hours of NMP in the HMP group, compared with controls. Cumulative bile production and biliary secretion of bilirubin and bicarbonate were significantly higher after HMP, compared with controls. In addition, the levels of lactate and glucose were less elevated after HMP compared with SCS preservation alone. In contrast, there were no differences in levels of hepatobiliary injury markers AST, ALT, LDH, and gamma-GT after 6 hours of NMP. Hepatic histology at baseline and after 6 hours of NMP revealed no differences in the amount of ischemic necrosis between both groups.<br />Conclusions: Two hours of oxygenated HMP after traditional SCS restores hepatic ATP levels and improves hepatobiliary function but does not reduce (preexisting) hepatobiliary injury in ECD livers.
- Subjects :
- Adenosine Triphosphate metabolism
Aged
Bicarbonates metabolism
Bile metabolism
Bilirubin metabolism
Biomarkers metabolism
Energy Metabolism drug effects
Female
Humans
Liver enzymology
Liver pathology
Liver physiopathology
Liver Function Tests
Liver Transplantation adverse effects
Male
Middle Aged
Necrosis
Oxygen Consumption drug effects
Time Factors
Tissue Survival
Cold Ischemia adverse effects
Donor Selection
Hypothermia, Induced
Liver surgery
Liver Transplantation methods
Oxygen pharmacology
Perfusion methods
Tissue Donors supply & distribution
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 100
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 26863473
- Full Text :
- https://doi.org/10.1097/TP.0000000000001081