R Yoshikawa1, H Obara2, N Matsuno3, N Morito1, M Gouchi4, M Otani4, T Shonaka4, H Takahashi4, S Enosawa5, T Hirano6, H Furukawa4. 1. Department of Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan. 2. Department of Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan; National Center for Child Health and Development, Tokyo, Japan. 3. Department of Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan; National Center for Child Health and Development, Tokyo, Japan; Department of Surgery, Asahikawa Medical University, Hokkaido, Japan. Electronic address: mtn@asahikawa-med.ac.jp. 4. Department of Surgery, Asahikawa Medical University, Hokkaido, Japan. 5. National Center for Child Health and Development, Tokyo, Japan. 6. Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
Abstract
BACKGROUND: Machine perfusion (MP) techniques are expected to prove useful for preserving the organ viability and recovering organ function for organ transplantation. Furthermore, an accurate assessment of organ viability using MP is important for expanding the donor criteria. In this study, an ex vivo reperfusion model (ERM) simulating transplantation using diluted autologous blood under normothermic conditions was evaluated for its utility of MP under subnormothermic conditions for livers donated after cardiac death (DCD). METHODS: The liver preservation methods for DCD porcine livers were evaluated using the ERM. This investigation was performed using a novel perfusion system developed by our research group. Porcine livers were procured with a warm ischemia time (WIT) of 60 minutes. The organs were then preserved using subnormothemic machine perfusion (SNMP) or static cold storage (CS) for 4 hours. We also compared these tissues with SNMP livers procured under a WIT of 0 minutes. After the preservation, the livers were reperfused for 2 hours using the ERM with diluted autologous blood oxygenated by a membrane oxygenator under NMP conditions. Reperfusion was evaluated based on perfusion flow dynamics and outflow of deviating enzymes. RESULTS: In the early stages of reperfusion, pressure in the blood vessels increased sharply in the CS group. Furthermore, the amount of aspartate aminotransferase accumulation was lower in the SNMP group than in the other groups. These results suggest ischemia-reperfusion injury is suppressed in SNMP conditions. CONCLUSION: An ERM has use in evaluating the utility of MP for the DCD liver.
BACKGROUND: Machine perfusion (MP) techniques are expected to prove useful for preserving the organ viability and recovering organ function for organ transplantation. Furthermore, an accurate assessment of organ viability using MP is important for expanding the donor criteria. In this study, an ex vivo reperfusion model (ERM) simulating transplantation using diluted autologous blood under normothermic conditions was evaluated for its utility of MP under subnormothermic conditions for livers donated after cardiac death (DCD). METHODS: The liver preservation methods for DCD porcine livers were evaluated using the ERM. This investigation was performed using a novel perfusion system developed by our research group. Porcine livers were procured with a warm ischemia time (WIT) of 60 minutes. The organs were then preserved using subnormothemic machine perfusion (SNMP) or static cold storage (CS) for 4 hours. We also compared these tissues with SNMP livers procured under a WIT of 0 minutes. After the preservation, the livers were reperfused for 2 hours using the ERM with diluted autologous blood oxygenated by a membrane oxygenator under NMP conditions. Reperfusion was evaluated based on perfusion flow dynamics and outflow of deviating enzymes. RESULTS: In the early stages of reperfusion, pressure in the blood vessels increased sharply in the CS group. Furthermore, the amount of aspartate aminotransferase accumulation was lower in the SNMP group than in the other groups. These results suggest ischemia-reperfusion injury is suppressed in SNMP conditions. CONCLUSION: An ERM has use in evaluating the utility of MP for the DCD liver.
Authors: Elizabeth Soo; Christopher Marsh; Robert Steiner; Lisa Stocks; Dianne B McKay Journal: Transplant Rev (Orlando) Date: 2019-10-17 Impact factor: 3.943