Ischemia Free Liver Procurement with Normothermic Machine Perfusion in a Porcine Model
Taylor M Coe, MD, Charles G Rickert MD PhD, Siavash Raigani MD, Nikolaos Serifis MD, Rudy Matheson, BS, James F Markmann MD PhD
Massachusetts General Hospital, Boston, MA
Background: Standard liver procurement involves cold storage, which results in ischemia reperfusion injury. Herein, we describe the novel technique and perfusion outcomes of ischemia free porcine liver procurement.
Methods: Three Yucatan pigs underwent ischemia free liver procurement with subsequent normothermic machine perfusion with pressure-controlled pulsatile arterial and continuous portal perfusion for 180 minutes. Perfusate was based upon Hemopure, an acellular polymerized bovine hemoglobin-based oxygen-carrier. The technique of ischemia free procurement required isolation of the abdominal aorta and hepatic artery from supraceliac to the superior mesenteric artery (SMA). The infra-SMA aorta, portal vein and infrahepatic inferior vena cava (IVC) were cannulated. The suprahepatic IVC and supraceliac aorta were ligated, and the perfusion circuit was initiated via the portal and arterial inflow. The remaining blood was flushed from the liver, and the outflow circuit was connected, establishing a closed perfusion circuit.
Results: The average liver weight was 647 g. The ischemia free procurement technique was feasible in each pig with no anatomical concerns. During perfusion, the average perfusate flow per 100 g of liver decreased from 79.2 ml/min to 63.3 ml/min over three hours, remaining in the expected range. The perfusate lactate decreased from 2.6 at one hour to 1.0 at three hours of perfusion.
Conclusion: This technique allows for successful cannulation and transition from the donorís native circulation to normothermic, oxygenated machine perfusion without a period of decreased blood flow. After 3 hours of NMP, the perfusate lactate level decreased, reflecting adequate tissue perfusion and oxygenation with a Hemopure based perfusate.
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