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, 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.