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Observational Study
. 2022 Aug;36(8):e14762.
doi: 10.1111/ctr.14762. Epub 2022 Jul 5.

Reducing cold ischemia time by donor liver "back-table" preparation under continuous oxygenated machine perfusion of the portal vein

Veerle A Lantinga  1 , Carlijn I Buis  1 , Robert J Porte  1 , Vincent E de Meijer  1 , Otto B van Leeuwen  1
Affiliations
Observational Study

Reducing cold ischemia time by donor liver "back-table" preparation under continuous oxygenated machine perfusion of the portal vein

Veerle A Lantinga et al. Clin Transplant. 2022 Aug.

Abstract

Introduction: Cold ischemia time is a well-known risk factor for the development of non-anastomotic biliary strictures (NAS) after liver transplantation. End-ischemic hypothermic oxygenated machine perfusion (HOPE) of DCD liver grafts reduces the incidence of NAS, and has the potential to reduce cold ischemia times. We hypothesized that if a part of the back-table procedure could be performed under continuous HOPE, cold ischemia times would be reduced.

Methods: In this prospective observational cohort study, all nationwide declined livers that underwent DHOPE-NMP between July 1st 2021 and January 1st 2022 were included. The back-table of ten consecutive high-risk donor livers was performed with ongoing HOPE. Sixty DHOPE-NMP procedures (August 1st 2017-July 1st 2021) with a conventional back-table procedure functioned as a control group.

Results: Compared to the control group, this technique led to a decrease in non-oxygenated back-table time from median 74 min (IQR 58-92 min) to median 25 min (IQR 21-31 min), p < .01. Median total cold preservation times were reduced from 279 min (IQR 254-297) to 214 min (IQR 132-254), p < .01.

Conclusion: Cold ischemia time of liver grafts can be successfully reduced by over one hour by using portal vein only HOPE during back-table preparation.

Keywords: cold ischemia time; liver; machine perfusion.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Back‐table procedure of a large, steatotic liver (2931 grams) under continuous single vessel (portal vein) hypothermic oxygenated machine perfusion (HOPE). (A) After initiation of HOPE, hilar dissection is continued with the identification and dissection of the arterial branches, as well as removal of hilar fat and lymph nodes. A gauze is placed underneath the liver to prevent debris entering the perfusion system. (B) After completion of the "back‐table procedure," dual HOPE through both the portal vein and hepatic artery is commenced.
See this image and copyright information in PMC

References

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