Randomized study on in situ liver perfusion techniques: Gravity perfusion VS high-pressure perfusion

Abstract

T HE VIABILITY of the donor liver depends on many factors such as perfusion techniques, perfusion solution and preservation methods. To date a number of studies have focused on perfusion solutions and preservation methods, but little is known about the effects of perfusion techniques and flow rate on organ viability in the clinical setting. In situ the liver can be easily perfused by a gravityidrostatic pressure perfusion of 75 to 100 cm H20. However some authors have advocated a more physiologic method in which the fluid is flushed under pressure (100 mm Hg) similar to the mean arterial blood pressure with the advantage of perfusing the small intrahepatic vessels, particularly those of the biliary tree, reducing post-transplantation ischemic damage and biliary complications. On the other hand, excessively high pressures would cause irreversible organ damage. To assess which in situ liver perfusion technique has the best outcome on early graft function after liver transplant, multiorgan donors were randomized to receive gravity perfusion or high-pressure perfusion.