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. 2022 Jun 1;106(6):1193-1200.
doi: 10.1097/TP.0000000000003945. Epub 2022 Sep 7.

Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling

Zhitao Chen  1   2   3 , Tielong Wang  1   2   3 , Chuanbao Chen  1   2   3 , Qiang Zhao  1   2   3 , Yihao Ma  1   2   3 , Yiwen Guo  1   2   3 , Xitao Hong  1   2   3 , Jia Yu  1   2   3 , Changjun Huang  1   2   3 , Weiqiang Ju  1   2   3 , Maogen Chen  1   2   3 , Xiaoshun He  1   2   3
Affiliations

Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling

Zhitao Chen et al. Transplantation. .

Abstract

Background: Traditional liver transplant strategies with cold preservation usually result in ischemia-reperfusion injury (IRI) to the donor liver. Regular normothermic machine perfusion (NMP) donor livers suffer IRI twice. Here, we aimed to introduce a novel technique called continuous NMP without recooling to avoid a second IRI and its application in livers from extended criteria donors.

Methods: Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups.

Results: During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60-180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462).

Conclusions: Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Information about ECD livers enrolled in our study. A, Definition of ECDs used in this pilot study. B, Criteria for viability assessment after perfusion. C, Study liver flowchart. DCD, donation after circulatory death; ECD, extended criteria donor; HBsAg, hepatitic B surface antigen; ICU, intensive care unit; LT, liver transplantation; NMP, normothermic machine perfusion.
FIGURE 2.
FIGURE 2.
Schematic diagram of NMP without recooling and changes in liver appearance during perfusion. A, Diagram of perfusion and implantation. B, The appearance of the liver before perfusion, with 1 h of perfusion, and before implantation. NMP, normothermic machine perfusion; PV, portal vein.
FIGURE 3.
FIGURE 3.
Study liver photographs. The figure shows all 28 livers used in this study. The red frames designate organs under NMP without recooling, the green frames designate organs under standard NMP, and the rest are under SCS. The table shows the reasons for every donor liver for ECDs. ALT, alanine aminotransferase; AST, aspartate aminotransferase; ECD, extended criteria donor; HBsAg, hepatitic B surface antigen; NMP, normothermic machine perfusion; SCS, static cold storage.
FIGURE 4.
FIGURE 4.
Parameter changes during perfusion in NMP without recooling: (A) pH, (B) partial pressure of carbon dioxide, (C) bicarbonate concentration, (D) lactate concentration, (E) potassium concentration, and (F) isolated calcium concentration. Lac, lactate; NMP, normothermic machine perfusion.
FIGURE 5.
FIGURE 5.
Comparison of liver function recovery between groups. Comparison of ALT, AST, and GGT (A); TBil and creatine (B); and INR (C) at 7 d posttransplantation and dynamic changes in ALT (D), AST (E), TBil (F), and INR (G) between groups at 14 d posttransplantation. ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; INR, international normalized ratio; NMP, normothermic machine perfusion; ns, nonsignificant; SCS, static cold storage; TBil, total bilirubin.
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