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Pretransplant sequential hypo‐ and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin‐based oxygen carrier perfusion solution
Author(s) -
Vries Yvonne,
Matton Alix P. M.,
Nijsten Maarten W. N.,
Werner Maureen J. M.,
Berg Aad P.,
Boer Marieke T.,
Buis Carlijn I.,
Fujiyoshi Masato,
Kleine Ruben H. J.,
Leeuwen Otto B.,
Meyer Peter,
Heuvel Marius C.,
Meijer Vincent E.,
Porte Robert J.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15228
Subject(s) - machine perfusion , perfusion , medicine , cold storage , transplantation , liver transplantation , viaspan , oxygen , anesthesia , cardiology , surgery , chemistry , biology , organic chemistry , horticulture
Ex situ dual hypothermic oxygenated machine perfusion ( DHOPE ) and normothermic machine perfusion ( NMP ) of donor livers may have a complementary effect when applied sequentially. While DHOPE resuscitates the mitochondria and increases hepatic adenosine triphosphate ( ATP ) content, NMP enables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE , NMP requires a perfusion solution with an oxygen carrier, for which red blood cells ( RBC ) have been used in most series. RBC , however, have limitations and cannot be used cold. We, therefore, established a protocol of sequential DHOPE , controlled oxygenated rewarming ( COR ), and NMP using a new hemoglobin‐based oxygen carrier ( HBOC )‐based perfusion fluid ( DHOPE ‐ COR ‐ NMP trial, NTR 5972). Seven livers from donation after circulatory death ( DCD ) donors, which were initially declined for transplantation nationwide, underwent DHOPE ‐ COR ‐ NMP . Livers were considered transplantable if perfusate pH and lactate normalized, bile production was ≥10 mL and biliary pH > 7.45 within 150 minutes of NMP . Based on these criteria five livers were transplanted. The primary endpoint, 3‐month graft survival, was a 100%. In conclusion, sequential DHOPE ‐ COR ‐ NMP using an HBOC ‐based perfusion fluid offers a novel method of liver machine perfusion for combined resuscitation and viability testing of suboptimal livers prior to transplantation.