Excorporeal normothermic machine perfusion resuscitates pig DCD livers with extended warm ischemia.

The shortage in donor livers has led to increased use of allografts derived from donation after cardiac death (DCD). The compromised viability in these livers leads to inferior post-transplantation allograft function and survival compared with donation after brain death (DBD) donor grafts. In this study, we reconditioned DCD livers using an optimized normothermic machine perfusion system. Livers from 12 Yorkshire pigs (20–30 kg) were subjected to either 0 min (WI-0 group, n = 6) or 60 min (WI-60 group, n = 6) of warm ischemia and 2 h of cold storage in UW solution, followed by 4 h of oxygenated sanguineous normothermic machine perfusion. Liver viability and metabolic function were analyzed hourly. Warm ischemic livers showed elevated transaminase levels and reduced ATP concentration. After the start of machine perfusion, transaminase levels stabilized and there was recovery of tissue ATP, coinciding with an increase in bile production. These parameters reached comparable levels to the control group after 1 h of machine perfusion. Histology and gross morphology confirmed recovery of the ischemic allografts. Our data demonstrate that metabolic and functional parameters of livers with extended warm ischemic time (60 min) can be significantly improved using normothermic machine perfusion. We hereby compound the existing body of evidence that machine perfusion is a viable solution for reconditioning marginal organs.

供体肝脏的短缺导致心脏死亡后捐献（DCD）来源的同种异体移植物的使用增加。与脑死亡后捐献（DBD）的供体移植物相比，这些肝脏的活力受损，导致移植后同种异体移植物的功能和存活率较差。在这项研究中，我们使用一种优化的常温机器灌注系统对DCD肝脏进行修复。 12头约克夏猪（20 - 30千克）的肝脏分别经历0分钟（WI - 0组，n = 6）或60分钟（WI - 60组，n = 6）的热缺血，并在威斯康星大学（UW）溶液中冷藏2小时，随后进行4小时的含氧血液常温机器灌注。每小时分析肝脏的活力和代谢功能。 热缺血肝脏显示转氨酶水平升高，三磷酸腺苷（ATP）浓度降低。机器灌注开始后，转氨酶水平稳定，组织ATP恢复，同时胆汁生成增加。机器灌注1小时后，这些参数达到与对照组相当的水平。组织学和大体形态学证实缺血同种异体移植物恢复。 我们的数据表明，使用常温机器灌注可以显著改善热缺血时间延长（60分钟）的肝脏的代谢和功能参数。我们在此补充了现有的证据，即机器灌注是修复边缘器官的一种可行的解决方案。