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. 2020 Nov;220(5):1270-1277.
doi: 10.1016/j.amjsurg.2020.06.072. Epub 2020 Aug 8.

Novel oxygenation technique for hypothermic machine perfusion of liver grafts: Validation in porcine Donation after Cardiac Death (DCD) liver model

Guergana G Panayotova  1 , Jesus Rosado  2 , Flavio Paterno  2 , Dayanand Deo  3 , George Dikdan  2 , Matthew A McCarty  2 , Ben Arrington  4 , Anthony Giudice  4 , Adam Fano  2 , Nehal Dhaduk  2 , Keri E Lunsford  2 , Prakash Rao  3 , James V Guarrera  5
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Novel oxygenation technique for hypothermic machine perfusion of liver grafts: Validation in porcine Donation after Cardiac Death (DCD) liver model

Guergana G Panayotova et al. Am J Surg. 2020 Nov.

Abstract

Background: Hypothermic oxygenated machine perfusion improves outcomes in Liver Transplantation, but application is limited as O2 is supplied by a stationary circuit. A novel technique of O2 "pre-charge" in a portable pump would broaden use and further mitigate ischemia damage from organ transport.

Methods: Porcine DCD livers were randomized to static cold storage (SCS, n = 8) or hypothermic machine perfusion (HMP). HMP was stratified into HMP-O2 (n = 5), non-O2 open to air HMP-RA (n = 5), and non-O2 with sealed lids or no air HMP-NA (n = 5). HMP-O2 was "pre-charged" using 100% O2 delivered at 10 L/min over 15 min. Perfusate and tissue O2 tension (pO2), liver biopsies, and fluid chemistries were analyzed.

Results: "Pre-charge" achieves sustained tissue and perfusate pO2 vs others. HMP-O2 results in decreased markers of hepatocyte injury: ALT (p < 0.05) and LDH (p < 0.05), lower expression of CRP and higher expression of SOD1 vs SCS. This suggests decreased inflammation and improved ROS scavenging.

Conclusions: "Pre-charge" is an effective technique, which allows portability and transport without an O2 source and improves graft parameters.

Keywords: Ex vivo perfusion; Hypothermic machine perfusion; Hypothermic oxygenated machine perfusion; Ischemia/reperfusion injury; Liver graft preservation; Liver transplantation.

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