Abstract
Oxygenated ex situ machine perfusion of donor livers is an alternative for static cold preservation that can be performed at temperatures from 0 °C to 37 °C. Organ metabolism depends on oxygen to produce adenosine triphosphate and temperatures below 37 °C reduce the metabolic rate and oxygen requirements. The transport and delivery of oxygen in machine perfusion are key determinants in preserving organ viability and cellular function. Oxygen delivery is more challenging than carbon dioxide removal, and oxygenation of the perfusion fluid is temperature dependent. The maximal oxygen content of water-based solutions is inversely related to the temperature, while cellular oxygen demand correlates positively with temperature. Machine perfusion above 20 °C will therefore require an oxygen carrier to enable sufficient oxygen delivery to the liver. Human red blood cells are the most physiological oxygen carriers. Alternative artificial oxygen transporters are hemoglobin-based oxygen carriers, perfluorocarbons, and an extracellular oxygen carrier derived from a marine invertebrate. We describe the principles of oxygen transport, delivery, and consumption in machine perfusion for donor livers using different oxygen carrier-based perfusion solutions and we discuss the properties, advantages, and disadvantages of these carriers and their use.
Highlights
Novel approaches are being explored to increase the number and quality of donor organs
The O2 requirements in hypothermic machine perfusion (HMP) and SNMP can be met by adding dissolved O2 in the perfusion fluid [13,34]
Machine perfusion (MP) is a dynamic organ preservation platform technology used to increase the number and quality of donor organs. It can be performed at different temperatures of the perfusate solution–varying from hypothermic to normothermic perfusion
Summary
Novel approaches are being explored to increase the number and quality of donor organs These methods are aimed to decrease the donor organ shortages in relation to the number of candidate recipients on the waiting list [1]. Hypothermic machine perfusion (HMP) ranges from 0 ◦ C to 12 ◦ C, at which the metabolic rate and energy expenditure of the organ is low. During HMP, organ viability and function cannot be assessed, because the liver is in a low metabolic state, but in addition it may prolong preservation time [10,11]. To obtain the preferred osmolality and colloid osmotic pressure, water, saline, and human albumin or another type of colloid are usually added [21,22] In this descriptive review we discuss the principles of gas transport during ex situ.
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