  
Normothermic extracorporeal perfusion preserves livers for transplantation
Last Updated: 2001-02-05 15:30:21 EST (Reuters Health)
WESTPORT, CT (Reuters Health) - Normothermic extracorporeal liver perfusion (NELP) can be used to preserve donor livers for at least 4 hours in a pig liver transplant model, according to results published in the January issue of the Annals of Surgery.
"The liver is kept in an organ perfusion chamber which mimics intra-abdominal pressures, and physiological perfusate flow rates are administered through the hepatic artery and portal vein," lead investigator Dr. Michael R. Schon told Reuters Health. "In theory, there is no end of a perfusion period if we supply the right amount of substrates and eliminate the waste products."
Dr. Schon and colleagues from Humboldt-Universitat, in Berlin, tested the feasibility of NELP in six groups of six pigs each that underwent liver transplantation after immediate transplant (group 1), cold liver storage in University of Wisconsin solution (UW) for 4 hours (group 2), NELP for 4 hours (group 3); transplant after 1 hour of warm ischemia (group 4), warm ischemia followed by cold liver storage in UW for 4 hours (group 5), or warm ischemia followed by NELP for 4 hours (group 6).
All pigs in groups 1, 2, 3, and 6 maintained normal graft function posttransplant, the report indicates, but all pigs in group 5 died of graft failure within 24 hours. One animal in group 4 died of primary graft failure 18 hours after transplant.
Though some liver function parameters deteriorated during warm ischemia, there were no differences between transaminase levels between the 30-minute and 4-hour measurements in any group, the researchers note. Bile production (a measure of function) was higher and enzyme peaks (a measure of injury) were lower in group 3 than in group 6, however.
Liver tissue from groups 4 and 5 showed massive hepatocellular damage, the report indicates, but biopsies from the other groups showed no irreversible tissue damage.
"In contrast to the static method of cold preservation," the investigators conclude, "NELP could be a major step forward if it were possible to maintain the physiologic metabolism of the graft extracorporeally during preservation."
In his comments to Reuters Health, Dr. Schon pointed out that NELP could "be used for testing marginal donor livers for their function, for perfusion of metastatic livers with high doses of chemotherapeutics, and to improve further the support for patients in fulminant hepatic failure."
Ann Surg 2001;233:114-123.
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