Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death

• Published in: American journal of transplantation Vol. 16; no. 1; pp. 353 - 357
• Main Authors: Watson, C. J. E., Kosmoliaptsis, V., Randle, L. V., Russell, N. K., Griffiths, W. J. H., Davies, S., Mergental, H., Butler, A. J.
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: donation after circulatory death; Heart Arrest; Humans; Liver - blood supply; Liver Transplantation; Male; Middle Aged; Organ Preservation; Perfusion; Preimplant ex situ normothermic liver perfusion; Prognosis; Tissue and Organ Procurement - methods; Tissue Donors; donation after circulatory death; liver transplantation; Preimplant ex situ normothermic liver perfusion
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.13448

Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57‐year‐old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life‐supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma‐free red cell–based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia. The authors report a liver transplant where ex situ normothermic machine perfusion was used to reduce cold ischemia and permit functional assessment of a donation after circulatory death liver before implantation.