Subnormothermic Machine Perfusion Preservation With Rewarming for Donation After Cardiac Death Liver Grafts in Pigs

Abstract

Background: The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. However, the implementation of such a strategy requires the development of novel preservation methods to recover from changes owing to warm ischemia. The aim of this study was to evaluate the effectiveness of subnormothermic machine perfusion (MP) preservation with rewarming for porcine DCD liver grafts for transplantation.

Methods: Porcine livers were perfused with newly developed MP system. The livers were perfused for 4 hours with modified University of Wisconsin gluconate solution. Group 1 grafts were preserved with no warm ischemia time (WIT) and hypothermic MP (HMP) for 4 hours. Group 2 grafts were preserved with WIT 60 minutes and HMP for 4 hours. Group 3 grafts were preserved with WIT 60 minutes and rewarming up to 25°C by MP (RMP) for 4 hours.

Results: The aspartate aminotransferase and lactate dehydrogenase in the effluent maintained at lower level in group 3 compared with group 2. However, tissue ATP levels did not recover in groups 2 and 3. Histologically, the fatty degenerate and swelling of the hepatocyte was slightly seen in all groups. The normal structure of the hepatocellular cords, the bile duct and the sinusoid endothelium were preserved in all groups.

Conclusions: Potentially, subnormothermic preservation with rewarming is expected to help the recovery of function for DCD liver grafts.