14 January 2020 : Original article
Applicability of Hypothermic Oxygenate Machine Perfusion Preservation for Split-Liver Transplantation in a Porcine Model: An Experimental Study
Daisuke Ishii1BE, Naoto Matsuno1ABG*, Mikako Gochi1B, Masahide Otani1B, Tatsuya Shonaka1B, Hiroyuki Takahashi1B, Yuji Nishikawa2CD, Ryo Yoshikawa3BC, Hiromichi Obara3B, Kazutoshi Miyamoto1A, Hiroyuki Furukawa1ADOI: 10.12659/AOT.919920
Ann Transplant 2020; 25:e919920
Abstract
BACKGROUND: Split-liver transplantation can be useful in situations of limited donor resources. However, novel preservation methods are required to help the recipient recover from severe ischemic reperfusion injury incurred due to receiving a relatively small liver graft.
MATERIAL AND METHODS: Our experiment was performed using porcine livers without warm ischemia time, assuming a brain-dead organ. We made porcine split-liver grafts by 75% liver resection at the back table and divided the specimens into 4 groups. Group 1 was preserved with simple cold storage after splitting (CS; n=3), Group 2 was preserved with hypothermic perfusion preservation (HMP) after splitting (SBP; n=3), Group 3 was preserved with HMP after splitting under perfusion preservation (SDP; n=4), and Group 4 had the whole liver perfused as control grafts (Whole Liver; n=3). To assess potential methods of preservation and their effects, all grafts were evaluated by an ex vivo isolated liver reperfusion model using diluted autologous blood.
RESULTS: Portal vein pressure resistances during reperfusion were low in Group3 (SDP). Hepatic artery pressure resistances during reperfusion were markedly higher in Group 1(CS) than in the other groups. The levels of AST and LDH were high and increased at 2 h after reperfusion in Group 1 (CS). The histological findings show that the liver cell structure was irregular in Group 1 (CS) but remained regular in Groups 2 (SBP) and 3 (SDP). Histological Suzuki scores were also significantly better in Groups 2 (SBP) and 3 (SDP) compared with Group 1 (CS).
CONCLUSIONS: Splitting the liver under machine perfusion preservation may help restore the function and reduce ischemia-reperfusion injury.
Keywords: Liver Transplantation, Organ Preservation, Liver, Models, Animal, Perfusion, Swine, warm ischemia
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