Background & Aims
Due to ethical rules in most countries, long ischemia times are unavoidable prior
to organ procurement of donors without a heartbeat, which can cause early graft failure
after liver transplantation or late biliary strictures. Hypothermic oxygenated machine
perfusion, used prior to graft implantation, may rescue these high risk organs.
Methods
Eight patients with end stage liver diseases received human livers, obtained after
controlled cardiac death (Maastricht category III), with a median donor warm ischemia
time of 38 min, followed by a standard cold flush and static storage at 4 °C. Hypothermic oxygenated perfusion (HOPE) was applied for 1–2 h prior to implantation through the portal vein. The HOPE-perfusate was cooled at
10 °C and oxygenated (pO2 60 kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below
3 mmHg.
Results
Each machine perfused liver graft disclosed excellent early function after transplantation.
The release of liver enzymes and kidney function, as well as ICU and hospital stays
were comparable or better than in matched liver grafts from brain death donors. No
evidence of intrahepatic biliary complications could be documented within a median
follow up of 8.5 months.
Conclusions
This is the first report on cold machine perfusion of human liver grafts obtained
after cardiac arrest and subsequent transplantation. Application of HOPE appears well
tolerated, easy-to-use, and protective against early and later injuries.
Abbreviations:
DCD (donation after cardiac death), DBD (Donation after brain death), HOPE (hypothermic oxygenated perfusion), ICU (intensive care unit), HCC (hepatocellular carcinoma), IC (ischemic cholangiopathy), MELD (model for end stage liver disease), DAMPs (danger associated molecular proteins)Keywords
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References
- Liver transplantation from Maastricht category 2 non-heart-beating donors: a source to increase the donor pool?.Transplant Proc. 2004; 36: 747-750
- Donation after cardio-circulatory death liver transplantation.World J Gastroenterol. 2012; 18: 4491-4506
- The price of donation after cardiac death in liver transplantation: a prospective cost-effectiveness study.Transpl Int. 2013; 26: 411-418
- Liver transplantation with grafts from controlled donors after cardiac death: a 20-year follow-up at a single center.Am J Transplant. 2010; 10: 602-611
- The choice of recipient does not have a bearing on early outcome in liver transplant patients receiving grafts from non-heart-beating donors: a reappraisal?.Transplant Proc. 2007; 39: 2675-2677
- Experience with liver and kidney allografts from non-heart-beating donors.Transplantation. 1995; 59: 197-203
- Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center.Am J Transplant. 2009; 9: 773-781
- The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story.Surgery. 2009; 146 ([discussion 552–543]): 543-552
- Rescue of the cold preserved rat liver by hypothermic oxygenated machine perfusion.Am J Transplant. 2006; 6: 903-912
- One hour hypothermic oxygenated perfusion (HOPE) protects nonviable liver allografts donated after cardiac death.Ann Surg. 2009; 250: 674-683
- Superior preservation of DCD livers with continuous normothermic perfusion.Ann Surg. 2011; 254: 1000-1007
- Normothermic perfusion: a new paradigm for organ preservation.Ann Surg. 2009; 250: 1-6
- Hypothermic reconditioning by gaseous oxygen improves survival after liver transplantation in the pig.Am J Transplant. 2011; 11: 2627-2634
- Novel short-term hypothermic oxygenated perfusion (HOPE) system prevents injury in rat liver graft from non-heart beating donor.Ann Surg. 2006; 244 ([discussion 976–967]): 968-976
- Hypothermic machine preservation in human liver transplantation: the first clinical series.Am J Transplant. 2010; 10: 372-381
- Kidney transplantation from donors without a heartbeat.N Engl J Med. 2002; 347: 248-255
- Hypothermic oscillating liver perfusion stimulates ATP synthesis prior to transplantation.J Surg Res. 1998; 80: 365-372
- Rat liver preservation by hypothermic oscillating liver perfusion compared to simple cold storage.Cryobiology. 1998; 36: 61-70
- Calcium prevents loss of glutathione and reduces oxidative stress upon reperfusion in the perfused liver.Int J Surg Invest. 2000; 2: 1-7
- Reduced oxidative stress during acellular reperfusion of the rat liver after hypothermic oscillating perfusion.Transplantation. 1999; 68: 44-50
- Detection of mitochondrial electron chain carrier redox status by transhepatic light intensity during rat liver reperfusion.Cryobiology. 2003; 47: 125-142
- Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts.J Hepatol. 2013; 58: 278-286
- Hepatocellular carcinoma.N Engl J Med. 2011; 365: 1118-1127
- The super-rapid technique in Maastricht category III donors: has it developed enough for marginal liver grafts from donors after cardiac death?.Curr Opin Organ Transplant. 2012; 17: 131-136
- The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis.Liver Transpl. 2011; 17: 674-684
- Characteristics associated with liver graft failure: the concept of a donor risk index.Am J Transplant. 2006; 6: 783-790
- Donation after cardiac death: the University of Wisconsin experience with liver transplantation.Ann Surg. 2005; 242: 724-731
- Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors.Transpl Int. 2012; 25: 838-846
- Biliary complications and outcomes of liver transplantation from donors after cardiac death.Liver Transpl. 2007; 13: 1645-1653
- Hypothermic oxygenated perfusion (HOPE) protects from biliary injury in a rodent model of DCD liver transplantation.J Hepatol. 2013; 59: 948-991
- Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center.Ann Surg. 2011; 254 ([discussion 722–713]): 716-722
- Single-center experience with liver transplantation from controlled non-heart beating donors: a viable source of grafts.Ann Surg. 2005; 242: 732-738
- Biliary complications after orthotopic liver transplantation from donors after cardiac death: broad spectrum of disease.Transplant Proc. 2010; 42: 3392-3398
- Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single-center experience.Liver Transpl. 2009; 15: 1028-1035
- Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors.Am J Transplant. 2010; 10: 2665-2672
- Liver transplantation following donation after cardiac death: an analysis using matched pairs.Liver Transpl. 2009; 15: 1072-1082
- Donation after cardiac death liver transplantation: predictors of outcome.Am J Transplant. 2010; 10: 2512-2519
- Ex vivo normothermic machine perfusion and viability testing of discarded human donor livers.Am J Transplant. 2013; 13: 1327-1335
- Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers.Liver Transpl. 2012; 18: 1495-1507
- Attempt to rescue discarded human liver grafts by end ischemic hypothermic oxygenated machine perfusion.Transplant Proc. 2011; 43: 3455-3459
- Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation.Am J Transplant. 2012; 12: 162-170
SAMW: Medical-Ethical Guidelines 2011: The determination of death in the context of organ transplantation: www.samw.ch/en/Ethics/Guidelines/Currently-valid-guidelines.html.
Article info
Publication history
Published online: December 02, 2013
Accepted:
November 23,
2013
Received in revised form:
November 22,
2013
Received:
July 15,
2013
Identification
Copyright
© 2013 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
