Normothermic extracorporeal perfusion of isolated porcine liver after warm ischaemia: a preliminary report.

Abstract

Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers. We conducted proof-of-concept experiments using a DCD model in the pig to assess the short-term (4 hours) feasibility and functional efficacy of NELP. Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation. Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.

• Authors: Rinaldo Bellomo, Satoshi Suzuki, Bruno Marino, Graeme K Starkey, Brenton Chambers, Michael A Fink, Bao Zhong Wang, Shane Houston, Glenn Eastwood, Paolo Calzavacca, Neil Glassford, Alison Skene, Daryl A Jones, Robert Jones
• Journal: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine (Crit Care Resusc) Vol. 14 Issue 3 Pg. 173-6 (Sep 2012) ISSN: 1441-2772 [Print] Australia
• PMID: 22963210 (Publication Type: Journal Article)

Chemical References

• Acetaminophen

Topics

• Acetaminophen (analysis)
• Animals
• Extracorporeal Circulation
• Liver (pathology)
• Liver Circulation
• Liver Transplantation
• Organ Preservation (methods)
• Perfusion (instrumentation, methods)
• Swine
• Temperature
• Warm Ischemia