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. 2020 Feb;26(2):215-226.
doi: 10.1002/lt.25668.

Ex Situ Liver Machine Perfusion: The Impact of Fresh Frozen Plasma

Qiang Liu  1 , Ahmed Hassan  1 , Daniele Pezzati  1 , Basem Soliman  1 , Laura Lomaglio  1 , Patrick Grady  2 , Laurent Del Angel Diaz  1 , Andrea Simioni  1 , Shana Maikhor  1 , John Etterling  1 , Giuseppe D'Amico  1 , Giuseppe Iuppa  1 , Teresa Diago Uso  1 , Koji Hashimoto  1 , Federico Aucejo  1 , Masato Fujiki  1 , Bijan Eghtesad  1 , Kazunari Sasaki  1 , Choon Hyuck David Kwon  1 , Jacek Cywinski  3 , Samuel Irefin  3 , Ana Bennett  1 , William Baldwin  4 , Charles Miller  1 , Cristiano Quintini  1
Affiliations

Ex Situ Liver Machine Perfusion: The Impact of Fresh Frozen Plasma

Qiang Liu et al. Liver Transpl. 2020 Feb.

Abstract

The primary aim of this single-center, phase 1 exploratory study was to investigate the safety, feasibility, and impact on intrahepatic hemodynamics of a fresh frozen plasma (FFP)-based perfusate in ex situ liver normothermic machine perfusion (NMP) preservation. Using an institutionally developed perfusion device, 21 livers (13 donations after brain death and 8 donations after circulatory death) were perfused for 3 hours 21 minutes to 7 hours 52 minutes and successfully transplanted. Outcomes were compared in a 1:4 ratio to historical control patients matched according to donor and recipient characteristics and preservation time. Perfused livers presented a very low resistance state with high flow during ex situ perfusion (arterial and portal flows 340 ± 150 and 890 ± 70 mL/minute/kg liver, respectively). This hemodynamic state was maintained even after reperfusion as demonstrated by higher arterial flow observed in the NMP group compared with control patients (220 ± 120 versus 160 ± 80 mL/minute/kg liver, P = 0.03). The early allograft dysfunction (EAD) rate, peak alanine aminotransferase (ALT), and peak aspartate aminotransferase (AST) levels within 7 days after transplantation were lower in the NMP group compared with the control patients (EAD 19% versus 46%, P = 0.02; peak ALT 363 ± 318 versus 1021 ± 999 U/L, P = 0.001; peak AST 1357 ± 1492 versus 2615 ± 2541 U/L, P = 0.001 of the NMP and control groups, respectively). No patient developed ischemic type biliary stricture. One patient died, and all other patients are alive and well at a follow-up of 12-35 months. No device-related adverse events were recorded. In conclusion, with this study, we showed that ex situ NMP of human livers can be performed safely and effectively using a noncommercial device and an FFP-based preservation solution. Future studies should further investigate the impact of an FFP-based perfusion solution on liver hemodynamics during ex situ normothermic machine preservation.

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