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Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers.
Liver Transpl 2012; 18(12):1495-507LT

Abstract

The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured.

Authors+Show Affiliations

Laboratory of Abdominal Transplant Surgery, Catholic University of Leuven, Leuven, Belgium. diethard.monbaliu@uz.kuleuven.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22987314

Citation

Monbaliu, Diethard, et al. "Preserving the Morphology and Evaluating the Quality of Liver Grafts By Hypothermic Machine Perfusion: a Proof-of-concept Study Using Discarded Human Livers." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 18, no. 12, 2012, pp. 1495-507.
Monbaliu D, Liu Q, Libbrecht L, et al. Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. Liver Transpl. 2012;18(12):1495-507.
Monbaliu, D., Liu, Q., Libbrecht, L., De Vos, R., Vekemans, K., Debbaut, C., ... Pirenne, J. (2012). Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 18(12), pp. 1495-507. doi:10.1002/lt.23550.
Monbaliu D, et al. Preserving the Morphology and Evaluating the Quality of Liver Grafts By Hypothermic Machine Perfusion: a Proof-of-concept Study Using Discarded Human Livers. Liver Transpl. 2012;18(12):1495-507. PubMed PMID: 22987314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. AU - Monbaliu,Diethard, AU - Liu,Qiang, AU - Libbrecht,Louis, AU - De Vos,Rita, AU - Vekemans,Katrien, AU - Debbaut,Charlotte, AU - Detry,Olivier, AU - Roskams,Tania, AU - van Pelt,Jos, AU - Pirenne,Jacques, PY - 2011/11/15/received PY - 2012/09/03/accepted PY - 2012/9/19/entrez PY - 2012/9/19/pubmed PY - 2013/5/23/medline SP - 1495 EP - 507 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 18 IS - 12 N2 - The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/22987314/Preserving_the_morphology_and_evaluating_the_quality_of_liver_grafts_by_hypothermic_machine_perfusion:_a_proof_of_concept_study_using_discarded_human_livers_ L2 - https://doi.org/10.1002/lt.23550 DB - PRIME DP - Unbound Medicine ER -