Effects of Subnormothermic Perfusion Before Transplantation for Liver Grafts from Donation After Cardiac Death: A Simplified Dripping Perfusion Method in Pigs

Y. Kakizaki, S. Miyagi, K. Shimizu, H. Kumata, M. Matsumura, Y. Miyazaki, K. Fukuoka, S. S. Uematsu, K. Tokodai, Y. Hara, C. Nakanishi, M. Unno, T. Kamei, M. Goto

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background: Liver transplantation from donors after cardiac death (DCD) provides a solution to the donor shortage. However, DCD liver grafts are associated with a high incidence of primary graft nonfunction. We investigated the effectiveness of subnormothermic porcine liver perfusion, before transplantation from DCD, on graft viability. Methods: Landrace pigs (25–30 kg) were randomly allocated to 3 groups (5 per group): heart-beating (HB) graft, transplanted after a 4-hour period of cold storage (CS); DCD graft, retrieved 20 minutes after apnea-induced cardiac arrest (respiratory withdrawal) and transplanted after a 4-hour period of CS; and subnormothermic ex vivo liver perfusion (SELP) graft, retrieved in the same manner as the DCD graft but perfused with a subnormothermic oxygenated Krebs-Henseleit buffer (21–25°C, 10–15 cm H2O) for 30 minutes in a simplified dripping manner, without a machine perfusion system, after the 4-hour period of CS, and subsequently transplanted. Results: Although all animals in the HB group survived for >7 days, all animals in the DCD group died within 12 hours after transplantation. In the SELP group, 2 recipients survived for >7 days and another 2 recipients were killed on day 5. The survival rate was significantly better for SELP than for DCD grafts (P =.0016). The values of tumor necrosis factor α were not significantly different between the SELP and HB groups. Preserved structure of the parenchyma was observed in the SELP group on histologic examination. Conclusions: A simplified subnormothermic perfusion before liver transplantation is expected to improve graft viability and survival.

Original languageEnglish
Pages (from-to)1538-1543
Number of pages6
JournalTransplantation Proceedings
Volume50
Issue number5
DOIs
Publication statusPublished - 2018 Jun

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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