Abstract
Current cold storage organ preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation of liver allografts. Long-term organ preservation using normothermic perfusion might not only allow organ viability assessment before transplantation, but also provide the means for further organ modifications under physiologic conditions. Previous research has shown that porcine livers can be transplanted successfully after normothermic preservation of 20 hours. In the present study we investigate whether similar methodology is capable of further extending the safe limit to 48 hours. In this study, livers from White Landrace pigs were preserved by normothermic, oxygenated sanguineous perfusion. After a 48-hour period of preservation, livers were transplanted into recipient pigs and followed for 5 days. Outcome parameters measured included markers of synthetic and metabolic liver function as well as hepatocellular injury and blood gas analysis during perfusion and follow-up. Histological assessment of morphological liver integrity was performed. All livers showed sustained bile production and metabolic activity throughout the preservation period. Low levels of hepatocellular damage were found. Following transplantation all liver grafts revealed excellent graft function and death-censored graft survival was 100%. Porcine livers were transplanted successfully following 48 hours normothermic machine preservation.
Highlights
Increasing the safe preservation time in liver transplantation is desirable for a number of reasons
The principles underlying cold preservation are slowing of metabolism and reduction of cell swelling due to the ionic composition of preservation solutions [7]
We have demonstrated in an early set of experiments that normothermic perfusion is capable of maintaining porcine livers in viable condition for durations of up to 72 hours [5]
Summary
Increasing the safe preservation time in liver transplantation is desirable for a number of reasons. Prolonged preservation would greatly benefit the logistics of liver transplantation, enabling enough time to assess the viability of a donor organ more objectively before. 48-hour liver normothermic preservation manufacturer OrganOx. PJF and CCC, in addition to being full-time academics at the University of Oxford, receive consultancy payments as nonexecutive medical and technical directors of OrganOx. TV, JGB, CCC, PJF are shareholders of OrganOx Ltd. committing the patient to surgery. Beyond that, it would allow time for therapeutic interventions that might even improve the quality and viability of the organ
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