Philipp Dutkowski1, Andrea Schlegel1, Michelle de Oliveira1, Beat Müllhaupt2, Fabienne Neff1, Pierre-Alain Clavien3. 1. Department of Surgery & Transplantation, University Hospital Zurich, Switzerland. 2. Department of Hepatology and Gastroenterology, University Hospital Zurich, Switzerland. 3. Department of Surgery & Transplantation, University Hospital Zurich, Switzerland. Electronic address: clavien@access.uzh.ch.
Abstract
BACKGROUND & AIMS: Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs. METHODS: Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38 min, followed by a standard cold flush and static storage at 4 °C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10 °C and oxygenated (pO2 60 kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3 mmHg. RESULTS: Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5 months. CONCLUSIONS: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.
BACKGROUND & AIMS: Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs. METHODS: Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38 min, followed by a standard cold flush and static storage at 4 °C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10 °C and oxygenated (pO2 60 kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3 mmHg. RESULTS: Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5 months. CONCLUSIONS: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.
Authors: B G Bruinsma; H Yeh; S Ozer; P N Martins; A Farmer; W Wu; N Saeidi; S Op den Dries; T A Berendsen; R N Smith; J F Markmann; R J Porte; M L Yarmush; K Uygun; M-L Izamis Journal: Am J Transplant Date: 2014-04-23 Impact factor: 8.086
Authors: Emre A Eren; Nicholas Latchana; Eliza Beal; Don Hayes; Bryan Whitson; Sylvester M Black Journal: Exp Clin Transplant Date: 2016-10 Impact factor: 0.945
Authors: Bote G Bruinsma; Tim A Berendsen; Maria-Louisa Izamis; Heidi Yeh; Martin L Yarmush; Korkut Uygun Journal: Nat Protoc Date: 2015-02-18 Impact factor: 13.491