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Review
. 2018;5(1):72-81.
doi: 10.1007/s40472-018-0178-9. Epub 2018 Jan 20.

From "Gut Feeling" to Objectivity: Machine Preservation of the Liver as a Tool to Assess Organ Viability

Christopher J E Watson  1   2 , Ina Jochmans  3   4
Affiliations
Review

From "Gut Feeling" to Objectivity: Machine Preservation of the Liver as a Tool to Assess Organ Viability

Christopher J E Watson et al. Curr Transplant Rep. 2018.

Abstract

Purpose of review: The purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers.

Recent findings: In both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo. Lactate clearance, glucose evolution and pH regulation during normothermic perfusion seem promising measures of viability. In addition, bile chemistry might inform on cholangiocyte viability and the likelihood of post-transplant cholangiopathy.

Summary: While the use of machine perfusion technology has the potential to reduce and even remove uncertainty regarding liver graft viability, analysis of large datasets, such as those derived from large multicenter trials of machine perfusion, are needed to provide sufficient information to enable viability parameters to be defined and validated .

Keywords: Liver transplantation; Machine perfusion; Normothermic perfusion; Organ preservation; Viability assessment.

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Conflict of interest statement

Compliance with Ethical StandardsIna Jochmans reports non-financial support from Astellas Pharma (for travel, accommodation and registration for conferences) and received speaker fees paid to institution from Sanofi Genzyme, outside the submitted work.This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Schematic drawing illustrating metabolic zonation in the liver with reference to glucose and ammonia metabolism. Blood entering the liver lobule in vivo through hepatic artery (HA) and portal vein (PV) branches is rich in hormones, nutrients and oxygen. Periportal (zone 1) metabolic processes will include those requiring such conditions, while perivenous (zone 3) hepatocytes may preferentially include those metabolic processes that are less dependent on high levels of oxygen, for example, or those requiring products made in the periportal hepatocytes, such as urea
Fig. 2
Fig. 2
Typical normothermic perfusion profiles. The figure shows schematic graphs with typical biochemical and resistance profiles during normothermic perfusion with our interpretation given our current state of knowledge. Profiles of viable hepatocellular compartment livers are denoted by solid black lines, while dashed lines denote grafts where viability might be in doubt, due to a slow lactate clearance, persistently raised perfusate glucose, rising perfusate transaminase concentration or requirement for continued bicarbonate support to maintain pH. The graphs also show the different biochemical profiles of bile depending on the viability of the ducts, where viable cholangiocytes producing bile with a pH > 7.5, low glucose (especially relative to the high perfusate glucose) and increasing bicarbonate. To date, there is no clinical evidence in support of bile production or hepatic resistance thresholds for viability
See this image and copyright information in PMC

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