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Predictor parameters of liver viability during porcine normothermic ex situ liver perfusion in a model of liver transplantation with marginal grafts
Author(s) -
LinaresCervantes Ivan,
Echeverri Juan,
Cleland Stuart,
Kaths Johann Moritz,
Rosales Roizar,
Goto Toru,
Kollmann Dagmar,
Hamar Matyas,
Urbanellis Peter,
Mazilescu Laura,
Ganesh Sujani,
Adeyi Oyedele A.,
Yip Paul,
Goryńska Paulina,
Bojko Barbara,
Goryński Krzysztof,
Grant David R.,
Selzner Nazia,
Wąsowicz Marcin,
Selzner Markus
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.15395
Subject(s) - medicine , machine perfusion , liver transplantation , perfusion , transplantation , urology , cold storage , gastroenterology , biology , horticulture
Normothermic ex situ liver perfusion ( NE s LP ) offers the opportunity to assess biomarkers of graft function and injury. We investigated NE s LP parameters (biomarkers and markers) for the assessment of liver viability in a porcine transplantation model. Grafts from heart‐beating donors ( HBD ), and from donors with 30 minutes (donation after cardiac death [ DCD ]30′), 70 minutes ( DCD 70′), and 120 minutes ( DCD 120′) of warm ischemia were studied. The HBD , DCD 30′, and DCD 70′‐groups had 100% survival. In contrast, 70% developed primary nonfunction ( PNF ) and died in the DCD 120′‐group. Hepatocellular function during NE s LP showed low lactate (≤1.1 mmol/L) in all the groups except the DCD 120′‐group (>2 mmol/L) at 4 hours of perfusion ( P = .04). The fold‐urea increase was significantly lower in the DCD 120′‐group (≤0.4) compared to the other groups (≥0.65) ( P = .01). As for cholangiocyte function, bile/perfusate glucose ratio was significantly lower (<0.6) in all the groups except the DCD 120′‐group (≥0.9) after 3 hours of perfusion (<0.01). Bile/perfusate Na+ ratio was significantly higher (≥1.2) after 3 hours of perfusion in all the groups except for the DCD 120′‐group (≤1) ( P < .01). Three hours after transplantation, the DCD 120′‐group had a significantly higher international normalized ratio (>5) compared to the rest of the groups (≤1.9) ( P = .02). Rocuronium levels were higher at all the time‐points in the animals that developed PNF during NE s LP and after transplantation. This study demonstrates that biomarkers and markers of hepatocellular and cholangiocyte function during NE s LP correlate with the degree of ischemic injury and posttransplant function.