Rewarming to subnormothermia for DCD liver graft with machine perfusion preservation in pigs

Naoto Matsuno^1,3, Hiromichi Obara¹, Toshihiko Hirano², Kiyoko Kubota³, Masako Fujiyama³, Shin Enosawa³

¹Mechanical Engineering, Tokyo Metropolitan University, Tokyo, Japan, ²Clinical Pharmachology, Tokyo Unversity of Pharmacy and life Sicience, Tokyo, Japan, ³Transplantaton and innovative surgery, National Center for Child Health and Development, Tokyo, Japan

Utilization of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. However, the implementation of such a strategy requires the development of novel preservation methods to recover from changes due to warm ischemia. To assess potential methods and effect, livers procured after 60 minutes of warm ischemic time (WIT) were perfused and preserved. 【Methods】Porcine livers were perfused with newly developed machine perfusion (MP ) system. The livers were perfused with modify UW-gluconate(UW-G) or amino solution(JPS). Euro-ollins (EC) was used for simple cold storage (CS). All grafts were procured after acute hemorrhagic shock and ventilator off. Group 1 (n=ï¼”): grafts were procured after WIT of 0 min and preserved with CS for 2 hrs. and hypothermic MP (HMP) with UW-G for 2 hrsas a positive control.. Group 2 (n=4): grafts were procured with WIT of 60 min and preserved with CS for 2 hrs and HMP with JPS for 2hrs. Group 3 (n=5): preserved with CS for 2 hrs and rewarming up to 25ËšC by MP with JPS for 2hrs. The preserved liver grafts were transplanted orthotopicaly 【Results】The release rate of AST, ALT and LDH in perfusate as the difference from initial value during MP maintained as low in Group 3. The serum AST and LDH levels in 2 hr after reperfusion were significantly lower in Group 1 and 3 than in Group 2, (AST; 596.0, 1203,3 and 535.5 IU/L, LDH;637.5, 1417.2, and 778.2 IU/Lin each group,). Histologically, the necrosis of hepatocytes were less severe in Group 3. Survival rate with good postop. in Group 1 and3 was 3/4 and 3/5 respectively, but 0/ï¼” in Group 2.【Conclusion】Rewarming up to subnormothermia iby MP is expected to facilitate the recovery and resuscitating function of DCD liver grafts.