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Case Reports
. 2018 Mar 28;2018(3):rjx218.
doi: 10.1093/jscr/rjx218. eCollection 2018 Mar.

Proof of concept: liver splitting during normothermic machine perfusion

Barney T F Stephenson  1 , Glenn K Bonney  2 , Richard W Laing  1 , Ricky H Bhogal  1 , Francesca Marcon  1 , Desley A H Neil  1 , M Thamara P R Perera  2 , Simon C Afford  1 , Hynek Mergental  2 , Darius F Mirza  2
Affiliations
Case Reports

Proof of concept: liver splitting during normothermic machine perfusion

Barney T F Stephenson et al. J Surg Case Rep. .

Abstract

Introduction: Despite utilizing extended criteria donors, there remains a shortage of livers for transplantation. No data exists on splitting donor livers with concurrent NMP-L.

Methods: A liver recovered from a donor after circulatory death was subjected to NMP-L using a red cell based fluid. During NMP-L, a 'classical' left lateral + right trisegmentectomy split was performed using an integrated bipolar/ultrasonic device. After splitting, blood flow was confirmed using Doppler ultrasound in each lobe.

Results: Prior to splitting, flow rates were maintained physiologically. Lactate decreased from 13.9 to 3.0 mmol/L. Lactate before and after splitting were similar in the hepatic arteries, portal veins and IVC. Doppler ultrasound demonstrated arterial and venous waveforms in both lobes after splitting.

Conclusions: 'Classical' liver splitting during NMP-L is feasible, maintaining viability of both lobes. Establishing this procedure may attenuate cold ischaemic injury, allow pre-implantation monitoring of both grafts and facilitate logistics of transplanting two grafts.

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Figures

Figure 1:
Figure 1:
Splitting of DCD liver with concurrent NMP-L. (A) Appearance of the right lobe of liver after parenchymal transection whilst continuing NMP-L. (B) Appearance of liver lobes on completion of splitting and NMP-L.
Figure 2:
Figure 2:
Characteristics of the liver subjected to NMP-L prior to splitting. (A) Hepatic arterial and portal venous flow rates; (B) lactate concentrations; (C) cumulative bile production; and (D) glucose concentrations.
Figure 3:
Figure 3:
Representative Doppler ultrasound images of parenchyma from liver split with concurrent NMP-L. (A) Hepatic arteriolar waveform; (B) portal venous waveform; and (C) hepatic venous waveform.
Figure 4:
Figure 4:
Representative histological samples to assess architectural integrity and necrosis by H&E staining (A, C, E, G) as well as glycogen content using Periodic acid-Schiff staining (B, D, F, H). Samples taken prior to commencement of NMP-L (A, B), after 3 h of NMP-L (C, D), after 6 h of NMP-L (E, F) and after parenchymal splitting with concurrent NMP-L (G, H).
See this image and copyright information in PMC

References

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