Abstract
Normothermic ex situ liver perfusion might allow viability assessment of livers before transplantation. Perfusion characteristics were studied in 47 liver perfusions, of which 22 resulted in transplants. Hepatocellular damage was reflected in the perfusate transaminase concentrations, which correlated with posttransplant peak transaminase levels. Lactate clearance occurred within 3 hours in 46 of 47 perfusions, and glucose rose initially during perfusion in 44. Three livers required higher levels of bicarbonate support to maintain physiological pH, including one developing primary nonfunction. Bile production did not correlate with viability or cholangiopathy, but bile pH, measured in 16 of the 22 transplanted livers, identified three livers that developed cholangiopathy (peak pH < 7.4) from those that did not (pH > 7.5). In the 11 research livers where it could be studied, bile pH > 7.5 discriminated between the 6 livers exhibiting >50% circumferential stromal necrosis of septal bile ducts and 4 without necrosis; one liver with 25‐50% necrosis had a maximum pH 7.46. Liver viability during normothermic perfusion can be assessed using a combination of transaminase release, glucose metabolism, lactate clearance, and maintenance of acid‐base balance. Evaluation of bile pH may offer a valuable insight into bile duct integrity and risk of posttransplant ischemic cholangiopathy.
Highlights
Reliable metrics to determine whether a liver is viable and safe to transplant are currently not available
This paper describes our observations on the biochemistry and perfusion characteristics of 47 human livers that were nor‐ mothermically perfused, of which 22 were transplanted
The available literature hints at hepatic artery (HA) and portal vein (PV) flow, lactate clearance,[5] and bile pro‐ duction,[6,15] with the only clinically based evidence being derived from six human liver perfusions.[5]
Summary
Reliable metrics to determine whether a liver is viable and safe to transplant are currently not available. Normothermic perfusion of the liver affords an opportunity for viability assessment. There have been case reports and small series of liver transplants following ex situ normothermic perfusion,[1,2,3,4,5] there are as yet no val‐ idated criteria predicting liver viability. We used readily available biochemical and physical measurements that could be analyzed during perfusion. From these studies, we have demonstrated criteria that may be helpful in determining viability and identified others that are not as discriminatory as has been suggested.[5,6]
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