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Journal of Artificial Organs

, Volume 21, Issue 4, pp 450–457 | Cite as

Oxygen consumption during hypothermic and subnormothermic machine perfusions of porcine liver grafts after cardiac death

  • Noriyuki Morito
  • Hiromichi ObaraEmail author
  • Naoto Matsuno
  • Shin Enosawa
  • Hiroyuki Furukawa
Original Article Others
  • 148 Downloads

Abstract

The use of grafts donated after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. Machine perfusion (MP) is a promising technology to improve DCD liver grafts. Several perfusion technologies under various temperature and oxygenation conditions have been suggested and are still debated. It is important to confirm the relationship between oxygen consumption and organ conditions during MP. In this study, we analyzed oxygen consumption during oxygenated MP of porcine DCD liver grafts under different temperature conditions: hypothermic and subnormothermic. Grafts exposed to 60 min of warm ischemia were perfused for 4 h with a modified UW-gluconate perfusate under hypothermic (HMP) and subnormothermic conditions. Oxygen consumption, pressures of the portal vein and hepatic artery, and effluent enzymes were analyzed. Oxygen consumption was strongly related to the graft temperature during MP. Effluent enzyme level of the LDH were lower in the high oxygen consumption group than in the low oxygen consumption group during MP. In summary, we found that high oxygen consumption under subnormothermic temperature conditions has several advantages over HMP for DCD liver graft preservation.

Keywords

Machine perfusion Organ preservation Organ transplantation Ischemia/reperfusion injury Subnormothermic 

Notes

Acknowledgements

This work was supported by JSPS KAKENHI (#15H03922 to H. Obara and N. Matsuno) from the Japan Society for the Promotion of Science (JSPS), the Ring Ring Project (26–105 to H. Obara) of the JKA Foundation, and a Grant-in-Aid for Innovative Research in Life Science from Asahikawa Medical University to N. Matsuno.

References

  1. 1.
    Le Dinh H, de Roover A, Kaba A, et al. Donation after cardio-circulatory death liver transplantation. World J Gastroenterol. 2012;18:4491.CrossRefGoogle Scholar
  2. 2.
    Cursio R, Gugenheim J. Ischemia-reperfusion injury and ischemic-type biliary lesions following liver transplantation. J Transpl. 2012; 2012: 164329.Google Scholar
  3. 3.
    Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transpl. 2013;13:253.CrossRefGoogle Scholar
  4. 4.
    Heidenhain C, Pratschke J, Puhl G, et al. Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation. Transpl Int. 2010;23:14CrossRefGoogle Scholar
  5. 5.
    Guarrera JV, Henry SD, Samstein B, et al. Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transpl. 2010;10:372.CrossRefGoogle Scholar
  6. 6.
    Dutkowski P, Graf R, Clavien PA. Rescue of the cold preserved rat liver by hypothermic oxygenated machine perfusion. Am J Transpl. 2006;6:903.CrossRefGoogle Scholar
  7. 7.
    Changani KK, Fuller BJ, Bryant DJ, et al. Non-invasive assessment of ATP regeneration potential of the preserved donor liver. A 31P MRS study in pig liver. J Hepatol. 1997;26:336.CrossRefGoogle Scholar
  8. 8.
    Dutkowski P, Schlegel A, de Oliveira M, Müllhaupt B, Neff F, Clavien P-A. HOPE for human liver grafts obtained from donors after cardiac death. J Hepatol. 2014;60:765.CrossRefGoogle Scholar
  9. 9.
    Fondevila C, Hessheimer AJ, Maathuis MH, et al. Superior preservation of DCD livers with continuous normothermic perfusion. Ann Surg. 2011;254:1000.CrossRefGoogle Scholar
  10. 10.
    Op den Dries S, Karimian N, Sutton ME, et al. Ex vivo normothermic machine perfusion and viability testing of discarded human donor livers. Am J Transpl. 2013;13:1327.CrossRefGoogle Scholar
  11. 11.
    Ravikumar R, Jassem W, Mergental H, et al. Liver transplantation after ex vivo normothermic machine preservation: a phase 1 (first-in-man) clinical trial. Am J Transpl. 2016;16:1779.CrossRefGoogle Scholar
  12. 12.
    Olschewski P, Gass P, Ariyakhagorn V, et al. The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers. Cryobiology. 2010;60:337.CrossRefGoogle Scholar
  13. 13.
    Bruinsma BG, Yeh H, Ozer S, et al. Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation. Am J Transpl. 2014;14:1400.CrossRefGoogle Scholar
  14. 14.
    Obara H, Matsuno N, Shigeta T, Enosawa S, Hirano T, Mizunuma H. Rewarming machine perfusion system for liver transplantation. J Med Device. 2013;7:41011.CrossRefGoogle Scholar
  15. 15.
    Compagnon P, Levesque E, Hentati H, et al. An oxygenated and transportable machine perfusion system fully rescues liver grafts exposed to lethal ischemic damage in a pig model of DCD liver transplantation. Transplantation. 2017;101:e205–13.CrossRefGoogle Scholar
  16. 16.
    Schlegel A, Dutkowski P. Role of hypothermic machine perfusion in liver transplantation. Transpl Int. 2014; 28:1–13.CrossRefGoogle Scholar
  17. 17.
    Schlegel A, De Rougemont O, Graf R, Clavien P-A, Dutkowski P. Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts. J Hepatol. 2013;58:278–86.  https://doi.org/10.1016/j.jhep.2012.10.004.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lüer B, Koetting M, Efferz P, Minor T. Role of oxygen during hypothermic machine perfusion preservation of the liver. Transpl Int. 2010;23:944–50.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Koetting M, Lüer B, Efferz P, Paul A, Minor T. Optimal time for hypothermic reconditioning of liver grafts by venous systemic oxygen persufflation in a large animal model. Transplantation. 2011;91:42–7.CrossRefGoogle Scholar
  20. 20.
    Li X, Elwell MR, Ryan AM, Ochoa R. Morphogenesis of postmortem hepatocyte vacuolation and liver weight increases in Sprague–Dawley rats. Toxicol Pathol. 2003;31:682.CrossRefGoogle Scholar
  21. 21.
    Monbaliu D, Libbrecht L, De Vos R, et al. The extent of vacuolation in non-heart-beating porcine donor liver grafts prior to transplantation predicts their viability. Liver Transpl. 2008;14:1256.CrossRefGoogle Scholar
  22. 22.
    Stegemann J, Minor T. Energy charge restoration, mitochondrial protection and reversal of preservation induced liver injury by hypothermic oxygenation prior to reperfusion. Cryobiology. 2009;58:331.CrossRefGoogle Scholar
  23. 23.
    Tolboom H, Izamis ML, Sharma N, et al. Subnormothermic machine perfusion at both 20 °C and 30 °C recovers ischemic rat livers for successful transplantation. J Surg Res. 2012;175:149.CrossRefGoogle Scholar
  24. 24.
    Furukori M, Matsuno N, Meng LT, et al. Subnormothermic machine perfusion preservation with rewarming for donation after cardiac death liver grafts in pigs. Transpl Proc. 2016;48:1239.CrossRefGoogle Scholar
  25. 25.
    Bochimoto H, Matsuno N, Ishihara Y, Shonaka T, Koga D. The ultrastructural characteristics of porcine hepatocytes donated after cardiac death and preserved with warm machine perfusion preservation. PLoS One. 2017;12:e0186352.CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  1. 1.Department of Mechanical EngineeringTokyo Metropolitan UniversityHachioujiJapan
  2. 2.Department of SurgeryAsahikawa Medical UniversityAsahikawaJapan
  3. 3.Clinical Research CenterNational Center for Child Health and DevelopmentTokyoJapan

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