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A reproducible extended ex-vivo normothermic machine liver perfusion protocol utilising improved nutrition and targeted vascular flows.

Authors :
Clarke G
Mao J
Hann A
Fan Y
Gupta A
Nutu A
Buckel Schaffner E
Kayani K
Murphy N
Bangash MN
Casey AL
Wootton I
Lawson AJ
Dasari BVM
Perera MTPR
Mergental H
Afford SC
Source :
Communications medicine [Commun Med (Lond)] 2024 Oct 24; Vol. 4 (1), pp. 214. Date of Electronic Publication: 2024 Oct 24.
Publication Year :
2024

Abstract

Background: Normothermic machine perfusion of donor livers has become standard practice in the field of transplantation, allowing the assessment of organs and safe extension of preservation times. Alongside its clinical uses, there has been expanding interest in extended normothermic machine perfusion (eNMP) of livers as a potential vehicle for medical research. Reproducible extended normothermic machine perfusion has remained elusive due to its increased complexity and monitoring requirements. We set out to develop a reproducible protocol for the extended normothermic machine perfusion of whole human livers.<br />Methods: Human livers declined for transplantation were perfused using a blood-based perfusate at 36 °C using the Liver Assist device (XVIVO, Sweden), with continuous veno-venous haemofiltration in-parallel. We developed the protocol in a stepwise fashion.<br />Results: Perfusion techniques utilised included: targeted physiological vascular flows, phosphate replacement (to prevent hypophosphataemia), N-acetylcysteine (to prevent methaemoglobin accumulation), and the utilisation of sodium lactate as both a nutritional source and real-time measure of hepatocyte function. All five human livers perfused with the developed protocol showed preserved function with a median perfusion time of 168 h (range 120-184 h), with preserved viability throughout.<br />Conclusions: Livers can be reproducibly perfused in excess of 120 (range 121-184) hours with evidence of preserved hepatocyte and cholangiocyte function.<br /> (© 2024. The Author(s).)

Details

Language :
English
ISSN :
2730-664X
Volume :
4
Issue :
1
Database :
MEDLINE
Journal :
Communications medicine
Publication Type :
Academic Journal
Accession number :
39448795
Full Text :
https://doi.org/10.1038/s43856-024-00636-2