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Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers

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Monbaliu, Diethard Liu, Qiang Libbrecht, Louis [UCL] De Vos, Rita Vekemans, Katrien Pirenne, Jacques

The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2012
Language Anglais
Journal information "Liver Transplantation" - Vol. 18, no.12, p. 1495-1507 (2012)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) Hoboken, NY)
issn 1527-6465
e-issn 1527-6473
Publication status Publié
Affiliation [UGent]
MESH Subject Adenosine Triphosphate ; Equipment Design ; Female ; Gene Expression Regulation ; Humans ; Hydrogen-Ion Concentration ; L-Lactate Dehydrogenase ; Lactic Acid ; Liver ; Liver Transplantation ; Male ; Adult ; Middle Aged ; Organ Preservation ; Organ Preservation Solutions ; Oxygen ; Partial Pressure ; Perfusion ; RNA, Messenger ; Time Factors ; Tissue Donors ; Vascular Resistance ; Aged ; Young Adult ; Aged, 80 and over ; Alanine Transaminase ; Aspartate Aminotransferases ; Biomarkers ; Carbon Dioxide ; Cold Temperature
Links
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Bibliographic reference Monbaliu, Diethard ; Liu, Qiang ; Libbrecht, Louis ; De Vos, Rita ; Vekemans, Katrien ; et. al. Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. In: Liver Transplantation, Vol. 18, no.12, p. 1495-1507 (2012)
Permanent URL http://hdl.handle.net/2078/187567