Open AccessRecovery of Warm Ischemic Rat Liver Grafts by Normothermic Extracorporeal Perfusion
Author(s) -
Herman Tolboom,
Roos E. Pouw,
Maria-Louisa Izamis,
Jack M Milwid,
Nripen Sharma,
Alejandro Soto-Gutiérrez,
Yaakov Nahmias,
Korkut Uygun,
François Berthiaume,
Martin L. Yarmush
Publication year - 2009
Publication title -
transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.45
H-Index - 204
eISSN - 1534-6080
pISSN - 0041-1337
DOI - 10.1097/tp.0b013e318192df6b
Subject(s) - medicine , ischemia , transplantation , perfusion , liver transplantation , machine perfusion , extracorporeal , cold storage , warm ischemia , economic shortage , surgery , urology , reperfusion injury , biology , linguistics , philosophy , government (linguistics) , horticulture
Liver transplantation is currently the only established treatment of end-stage liver disease, but it is limited by a severe shortage of viable donor livers. Donors after cardiac death (DCD) are an untapped source that could significantly increase the pool of available livers. Preservation of these DCD livers by conventional static cold storage (SCS) is associated with an unacceptable risk of primary nonfunction and delayed graft failure. Normothermic extracorporeal liver perfusion (NELP) has been suggested as an improvement over SCS. Livers recovered from male Lewis rats were subjected to 1 hr of warm ischemia and preserved with 5 hr of SCS or NELP, and transplanted into syngeneic recipients. As additional controls, non-ischemic livers preserved with 6 hr of SCS or NELP and unpreserved ischemic livers were transplanted. After NELP, ischemically damaged livers could be orthotopically transplanted into syngeneic recipients with 92% survival (n=13) after 4 weeks, which was comparable with control animals that received healthy livers preserved by SCS (n=9) or NELP (n=11) for 6 hr. On the other hand, animals from ischemia/SCS control group all died within 12 hr postoperatively (n=6). Similarly, animals that received ischemic livers without preservation all died within 24 hr after transplantation (n=6). These results suggest that NELP has the potential to reclaim warm ischemic livers that would not be transplantable otherwise. The rat model in this study is a useful platform to further optimize NELP as a method of recovery and preservation of DCD livers.