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N-acetylcysteine: a novel approach to methaemoglobinaemia in normothermic liver machine perfusion.

Authors :
Clarke G
Mao J
Fan Y
Hann A
Gupta A
Nutu A
Buckel E
Kayani K
Murphy N
Bangash MN
Casey AL
Wootton I
Lawson AJ
Dasari BVM
Perera MTPR
Mergental H
Afford SC
Source :
Scientific reports [Sci Rep] 2023 Nov 03; Vol. 13 (1), pp. 19022. Date of Electronic Publication: 2023 Nov 03.
Publication Year :
2023

Abstract

Extended duration of normothermic machine perfusion (NMP) provides opportunities to resuscitate suboptimal donor livers. This intervention requires adequate oxygen delivery typically provided by a blood-based perfusion solution. Methaemoglobin (MetHb) results from the oxidation of iron within haemoglobin and represents a serious problem in perfusions lasting > 24 h. We explored the effects of anti-oxidant, N-acetylcysteine (NAC) on the accumulation of methaemoglobin. NMP was performed on nine human donor livers declined for transplantation: three were perfused without NAC (no-NAC group), and six organs perfused with an initial NAC bolus, followed by continuous infusion (NAC group), with hourly methaemoglobin perfusate measurements. In-vitro experiments examined the impact of NAC (3 mg) on red cells (30 ml) in the absence of liver tissue. The no-NAC group sustained perfusions for an average of 96 (range 87-102) h, universally developing methaemoglobinaemia (≥ 2%) observed after an average of 45 h, with subsequent steep rise. The NAC group was perfused for an average of 148 (range 90-184) h. Only 2 livers developed methaemoglobinaemia (peak MetHb of 6%), with an average onset of 116.5 h. Addition of NAC efficiently limits formation and accumulation of methaemoglobin during NMP, and allows the significant extension of perfusion duration.<br /> (© 2023. The Author(s).)

Details

Language :
English
ISSN :
2045-2322
Volume :
13
Issue :
1
Database :
MEDLINE
Journal :
Scientific reports
Publication Type :
Academic Journal
Accession number :
37923778
Full Text :
https://doi.org/10.1038/s41598-023-45206-z