A Novel Oxygenated Machine Perfusion System for Preservation of the Liver

• Published in: Artificial organs 2013-08, Vol.37 (8), p.719-724
• Main Authors: Dirkes, Marcel C., Post, Ivo C.J.H., Heger, Michal, van Gulik, Thomas M.
• Format: Article
• Language: English
• Subjects: Adenosine - metabolism; Allografts; Allopurinol - metabolism; Animals; Blood Gas Analysis; Cold Temperature; Equipment Design; Extracorporeal hypothermic machine perfusion; Female; Glutathione - metabolism; Insulin - metabolism; Liver - blood supply; Liver - physiology; Liver - ultrastructure; Liver and kidney transplantation; Organ preservation; Organ Preservation - instrumentation; Organ Preservation Solutions - metabolism; Oxygen - blood; Oxygen - metabolism; Perfusion - instrumentation; Raffinose - metabolism; Swine
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.12071

Machine perfusion (MP) is a potential method to increase the donor pool for organ transplantation. However, MP systems for liver grafts remain difficult to use because of organ‐specific demands. Our aim was to test a novel, portable MP system for hypothermic preservation of the liver. A portable, pressure‐regulated, oxygenated MP system designed for kidney preservation was adapted to perfuse liver grafts via the portal vein (PV). Three porcine livers underwent 20 h of hypothermic perfusion using Belzer MP solution. The MP system was assessed for perfusate flow, temperature, venous pressure, and pO2/pCO2 during the preservation period. Biochemical and histological parameters were analyzed to determine postpreservation organ damage. Perfusate flow through the PV increased over time from 157 ± 25 mL/min at start to 177 ± 25 mL/min after 20 h. PV pressure remained stable at 13 ± 1 mm Hg. Perfusate temperature increased from 9.7 ± 0.6°C at the start to 11.0 ± 0.0°C after 20 h. Aspartate aminotransferase and lactate dehydrogenase increased from 281 ± 158 and 308 ± 171 U/L after 1 h to 524 ± 163 and 537 ± 168 U/L after 20 h, respectively. Blood gas analysis showed a stable pO2 of 338 ± 20 mm Hg before perfusion of the liver and 125 ± 14 mm Hg after 1 h perfusion. The pCO2 increased from 15 ± 5 mm Hg after 1 h to 53 ± 4 mm Hg after 20 h. No histological changes were found after 20 h of MP. This study demonstrated the feasibility of a portable MP system for preservation of the liver and showed that continuous perfusion via the PV can be maintained with an oxygen‐driven pump system without notable preservation damage of the organ.