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

摘要

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, style="fixed-case">NTR5972). Seven livers from donation after circulatory death ( style="fixed-case">DCD) donors, which were initially declined for transplantation nationwide, underwent style="fixed-case">DHOPE‐ style="fixed-case">COR‐ style="fixed-case">NMP. Livers were considered transplantable if perfusate style="fixed-case">pH and lactate normalized, bile production was ≥10 mL and biliary style="fixed-case">pH > 7.45 within 150 minutes of style="fixed-case">NMP. Based on these criteria five livers were transplanted. The primary endpoint, 3‐month graft survival, was a 100%. In conclusion, sequential style="fixed-case">DHOPE‐ style="fixed-case">COR‐ style="fixed-case">NMP using an style="fixed-case">HBOC‐based perfusion fluid offers a novel method of liver machine perfusion for combined resuscitation and viability testing of suboptimal livers prior to transplantation.