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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.

american journal of transplantation

Pretransplant sequential hypo‐ and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin‐based oxygen carrier perfusion solution