Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;47(10):1592-1603.
doi: 10.1111/aor.14622. Epub 2023 Aug 7.

Viability assessment of livers donated after circulatory determination of death during normothermic regional perfusion

Irene Steinberg  1   2   3 , Damiano Patrono  4 , Enrico De Cesaris  1 , Michele Lucà  1 , Giorgia Catalano  4 , Matteo Marro  5 , Giorgia Rizza  4 , Erika Simonato  5 , Luca Brazzi  1   2 , Renato Romagnoli  2   4 , Marinella Zanierato  1
Affiliations
Free article

Viability assessment of livers donated after circulatory determination of death during normothermic regional perfusion

Irene Steinberg et al. Artif Organs. 2023 Oct.
Free article

Abstract

Background: Abdominal normothermic regional perfusion (A-NRP) allows in-situ reperfusion and recovery of abdominal organs metabolism in donors after circulatory death (DCD). Besides improving liver transplantation outcomes, liver injury and function can be assessed during A-NRP.

Methods: To refine liver viability assessment during A-NRP, prospectively collected data of controlled DCD donors managed at our Institution between October 2019 and May 2022 were retrospectively analyzed. Baseline characteristics, procedural variables and A-NRP parameters of donors whose liver was successfully transplanted were compared to those of donors whose liver was discarded.

Results: Twenty-seven donors were included and in 20 (74%) the liver was accepted (positive outcome). No differences between study groups were observed concerning baseline characteristics and warm ischemia times (WIT). Initial lactate levels were positively correlated with functional WIT (r2 = 0.4, p = 0.04), whereas transaminase levels were not. Blood flow during A-NRP was comparable, whereas oxygen consumption (VO2 ) was significantly higher in the positive outcome group after 1 h. Time courses of lactate, AST and ALT were significantly different between study groups (p < 0.001). Donors whose liver was accepted showed faster lactate clearance, a difference which was amplified by normalizing lactate clearance to oxygen delivery (DO2 ) and VO2 . Lactate clearance was correlated to transaminase levels and DO2 -normalized lactate clearance was the parameter best discriminating between study groups.

Conclusions: DO2 -normalized lactate clearance may represent an element of liver viability assessment during A-NRP.

Keywords: donation after circulatory death; ex-situ machine perfusion; hypothermic oxygenated machine perfusion; lactate clearance; liver viability assessment; normothermic machine perfusion; normothermic regional perfusion; oxygen delivery.

PubMed Disclaimer

References

REFERENCES

    1. Callaghan CJ, Charman SC, Muiesan P, Powell JJ, Gimson AE, van der Meulen JH, et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open. 2013;3:e003287.
    1. Carbone M, Nardi A, Marianelli T, Martin K, Hudson A, Collett D, et al. International comparison of liver transplant programmes: differences in indications, donor and recipient selection and outcome between Italy and UK. Liver Int. 2016;36:1481-1489.
    1. Mateo R, Cho Y, Singh G, Stapfer M, Donovan J, Kahn J, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant. 2006;6:791-796.
    1. Fondevila C, Hessheimer AJ, Ruiz A, Calatayud D, Ferrer J, Charco R, et al. Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant. 2007;7:1849-1855.
    1. De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, et al. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int. 2021;34:2046-2060.