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. 2021 Feb 4;7(3):e666.
doi: 10.1097/TXD.0000000000001116. eCollection 2021 Mar.

Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation

Adam M Thorne  1 , Veerle Lantinga  1 , Silke Bodewes  1 , Ruben H J de Kleine  1 , Maarten W Nijkamp  1 , Joost Sprakel  1 , Hermien Hartog  2 , Wojciech G Polak  2 , Robert J Porte  1 , Vincent E de Meijer  1
Affiliations

Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation

Adam M Thorne et al. Transplant Direct. .

Abstract

Liver splitting allows the opportunity to share a deceased graft between 2 recipients but remains underutilized. We hypothesized that liver splitting during continuous dual hypothermic oxygenated machine perfusion (DHOPE) is feasible, with shortened total cold ischemia times and improved logistics. Here, we describe a left lateral segment (LLS) and extended right lobe (ERL) liver split procedure during continuous DHOPE preservation with subsequent transplantation at 2 different centers.

Methods: After transport using static cold storage, a 51-year-old brain death donor liver underwent end-ischemic DHOPE. During DHOPE, the donor liver was maintained <10 °C and oxygenated with a Po2 of >106 kPa. An ex situ ERL/LLS split was performed with continuing DHOPE throughout the procedure to avoid additional ischemia time.

Results: Total cold ischemia times for the LLS and ERL were 205 minutes and 468 minutes, respectively. Both partial grafts were successfully transplanted at 2 different transplant centers. Peak aspartate aminotransferase and alanine aminotransferase were 172 IU/L and 107 IU/L for the LLS graft, and 839 IU/L and 502 IU/L for the ERL graft, respectively. The recipient of the LLS experienced an episode of acute cellular rejection. The ERL transplantation was complicated by severe acute pancreatitis with jejunum perforation requiring percutaneous drainage and acute cellular rejection. No device-related adverse events were observed.

Conclusions: Liver splitting during continuous DHOPE preservation is feasible, has the potential to substantially shorten cold ischemia time and may optimize transplant logistics. Therefore liver splitting with DHOPE can potentially improve utilization of split liver transplantation.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Timeline of dual hypothermic oxygenated machine perfusion (DHOPE) split liver procedure into the left lateral segment (LLS) and extended right lobe (ERL). CIT, cold ischemia time; HA, hepatic artery; PV, portal vein; SCS, static cold storage.
FIGURE 2.
FIGURE 2.
The progression of the split procedure is observable from (A) start of dual hypothermic oxygenated machine perfusion (DHOPE), (B) start of left lateral segment (LLS)/extended right lobe (ERL) liver split with division of the middle and left hepatic vein with magnification of the transection plane, (C) midway through parenchymal liver split using the CUSA device, (D) demonstrating full parenchymal separation of the LLS from the ERL, and (E) showing dual perfusion of the ERL only, after the LLS has been fully removed. CUSA, Cavitron ultrasonic surgical aspirator; GB, gall bladder; HA, hepatic artery; PV, portal vein; TP, transection plane.
FIGURE 3.
FIGURE 3.
Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and total lactate levels in the recipients of (A) left lateral segment (LLS) and (B) extended right lobe (ERL) during the first 3 mo after transplantation. The increase in AST and ALT 5 d posttransplant seen in the LLS graft recipient is reflective of an episode of (biopsy-proven) acute rejection.
See this image and copyright information in PMC

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