Abstract
In transplantation, livers are transported to recipients using static cold storage (SCS), whereby livers are exposed to cold ischemic injury that contribute to post-transplant risk factors. We hypothesized that flushing organs during procurement with cold preservation solutions could influence the number of donor blood cells retained in the allograft thereby exacerbating cold ischemic injury. We present the results of rat livers that underwent 24 h SCS after being flushed with a cold University of Wisconsin (UW) solution versus room temperature (RT) lactated ringers (LR) solution. These results were compared to livers that were not flushed prior to SCS and thoroughly flushed livers without SCS. We used viability and injury metrics collected during normothermic machine perfusion (NMP) and the number of retained peripheral cells (RPCs) measured by histology to compare outcomes. Compared to the cold UW flush group, livers flushed with RT LR had lower resistance, lactate, AST, and ALT at 6 h of NMP. The number of RPCs also had significant positive correlations with resistance, lactate, and potassium levels and a negative correlation with energy charge. In conclusion, livers exposed to cold UW flush prior to SCS appear to perform worse during NMP, compared to RT LR flush.
Highlights
In transplantation, livers are transported to recipients using static cold storage (SCS), whereby livers are exposed to cold ischemic injury that contribute to post-transplant risk factors
Sprague Dawley rats were procured and subjected to one of the following conditions (n = 4 per group): (1) room temperature (RT) lactated ringers (LR) flush with no SCS, (2) cold University of Wisconsin (UW) flush with 24 h SCS, (3) RT LR flush with 24 h SCS, or (4) no flush with 24 h SCS (Fig. 1A)
Based on the knowledge that retained peripheral cells (RPCs) in a liver graft and flushing solutions perform poorly in cold, we hypothesized that livers procured with a room temperature (RT) lactated ringers flush would perform better than a cold UW flush using an ex-vivo rat liver normothermic machine perfusion model and lead to less RPCs after NMP
Summary
Livers are transported to recipients using static cold storage (SCS), whereby livers are exposed to cold ischemic injury that contribute to post-transplant risk factors. We hypothesized that flushing organs during procurement with cold preservation solutions could influence the number of donor blood cells retained in the allograft thereby exacerbating cold ischemic injury. We present the results of rat livers that underwent 24 h SCS after being flushed with a cold University of Wisconsin (UW) solution versus room temperature (RT) lactated ringers (LR) solution. These results were compared to livers that were not flushed prior to SCS and thoroughly flushed livers without SCS. Even after cold flushing, donor blood remains in the liver allograft, which may be harmful to resident cells, especially during SCS. Hypothermia has been linked to coagulopathy due to decreased fibrinogen a vailability[18]
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