Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers

Babak Banan, Haniee Chung, Zhenyu Xiao, Yaman Tarabishy, Jianluo Jia, Pamela Manning, G. A. Upadhya, Thalachallour Mohanakumar, Yiing Lin, William C. Chapman

Research output: Contribution to journalArticle

Abstract

Background The susceptibility of extended criteria livers to ischemia reperfusion injury is a major obstacle in organ cold preservation. Normothermic extracorporeal liver perfusion (NELP) has been investigated to reduce ischemic damage, restore physiologic function, and assess viability of the liver prior to transplant. The goal of this study is to compare physiological parameters of livers maintained continuously on NELP to those preserved in cold solution. Methods Livers from 9 female landrace pigs were subjected to either 20 minutes (W20-NELP), 40 minutes (W40-NELP), or 60 minutes (W60-NELP) of warm ischemia followed by 6 hours of NELP followed by a 2-hour NELP evaluation phase. This was compared with 3 livers subjected to 40 minutes of warm ischemia time followed by 6 hours of cold storage (W40-Cold) and a 2-hour NELP evaluation phase. Groups were compared with the 2-way analysis of variance test. Results NELP stabilized transaminases accompanied by significant improvement in bile production and decline in lactate and INR values in all W-NELP groups. Histologic analysis demonstrated significant improvement from 0 hour (mild-to-moderate sinusoidal dilation and zone 3 necrosis) to the end of the NELP run (minimal necrosis and mild IRI). Comparison of W40-NELP and W40-Cold revealed greater bile production and oxygen extraction ratio in W40-NELP. In contrast, markers of cellular and functional damage were increased in the W40-Cold group. Conclusion NELP improves metabolic and functional parameters of livers with either short or extended warm ischemia times compared with livers subjected to comparable cold ischemia times.

Original languageEnglish (US)
Pages (from-to)1642-1650
Number of pages9
JournalSurgery (United States)
Volume158
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Perfusion
Liver
Warm Ischemia
Bile
Necrosis
Organ Preservation
Cold Ischemia
International Normalized Ratio
Transaminases
Reperfusion Injury
Dilatation
Lactic Acid
Analysis of Variance

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers. / Banan, Babak; Chung, Haniee; Xiao, Zhenyu; Tarabishy, Yaman; Jia, Jianluo; Manning, Pamela; Upadhya, G. A.; Mohanakumar, Thalachallour; Lin, Yiing; Chapman, William C.

In: Surgery (United States), Vol. 158, No. 6, 01.12.2015, p. 1642-1650.

Research output: Contribution to journalArticle

Banan, B, Chung, H, Xiao, Z, Tarabishy, Y, Jia, J, Manning, P, Upadhya, GA, Mohanakumar, T, Lin, Y & Chapman, WC 2015, 'Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers', Surgery (United States), vol. 158, no. 6, pp. 1642-1650. https://doi.org/10.1016/j.surg.2015.07.016
Banan, Babak ; Chung, Haniee ; Xiao, Zhenyu ; Tarabishy, Yaman ; Jia, Jianluo ; Manning, Pamela ; Upadhya, G. A. ; Mohanakumar, Thalachallour ; Lin, Yiing ; Chapman, William C. / Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers. In: Surgery (United States). 2015 ; Vol. 158, No. 6. pp. 1642-1650.
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T1 - Normothermic extracorporeal liver perfusion for donation after cardiac death (DCD) livers

AU - Banan, Babak

AU - Chung, Haniee

AU - Xiao, Zhenyu

AU - Tarabishy, Yaman

AU - Jia, Jianluo

AU - Manning, Pamela

AU - Upadhya, G. A.

AU - Mohanakumar, Thalachallour

AU - Lin, Yiing

AU - Chapman, William C.

PY - 2015/12/1

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N2 - Background The susceptibility of extended criteria livers to ischemia reperfusion injury is a major obstacle in organ cold preservation. Normothermic extracorporeal liver perfusion (NELP) has been investigated to reduce ischemic damage, restore physiologic function, and assess viability of the liver prior to transplant. The goal of this study is to compare physiological parameters of livers maintained continuously on NELP to those preserved in cold solution. Methods Livers from 9 female landrace pigs were subjected to either 20 minutes (W20-NELP), 40 minutes (W40-NELP), or 60 minutes (W60-NELP) of warm ischemia followed by 6 hours of NELP followed by a 2-hour NELP evaluation phase. This was compared with 3 livers subjected to 40 minutes of warm ischemia time followed by 6 hours of cold storage (W40-Cold) and a 2-hour NELP evaluation phase. Groups were compared with the 2-way analysis of variance test. Results NELP stabilized transaminases accompanied by significant improvement in bile production and decline in lactate and INR values in all W-NELP groups. Histologic analysis demonstrated significant improvement from 0 hour (mild-to-moderate sinusoidal dilation and zone 3 necrosis) to the end of the NELP run (minimal necrosis and mild IRI). Comparison of W40-NELP and W40-Cold revealed greater bile production and oxygen extraction ratio in W40-NELP. In contrast, markers of cellular and functional damage were increased in the W40-Cold group. Conclusion NELP improves metabolic and functional parameters of livers with either short or extended warm ischemia times compared with livers subjected to comparable cold ischemia times.

AB - Background The susceptibility of extended criteria livers to ischemia reperfusion injury is a major obstacle in organ cold preservation. Normothermic extracorporeal liver perfusion (NELP) has been investigated to reduce ischemic damage, restore physiologic function, and assess viability of the liver prior to transplant. The goal of this study is to compare physiological parameters of livers maintained continuously on NELP to those preserved in cold solution. Methods Livers from 9 female landrace pigs were subjected to either 20 minutes (W20-NELP), 40 minutes (W40-NELP), or 60 minutes (W60-NELP) of warm ischemia followed by 6 hours of NELP followed by a 2-hour NELP evaluation phase. This was compared with 3 livers subjected to 40 minutes of warm ischemia time followed by 6 hours of cold storage (W40-Cold) and a 2-hour NELP evaluation phase. Groups were compared with the 2-way analysis of variance test. Results NELP stabilized transaminases accompanied by significant improvement in bile production and decline in lactate and INR values in all W-NELP groups. Histologic analysis demonstrated significant improvement from 0 hour (mild-to-moderate sinusoidal dilation and zone 3 necrosis) to the end of the NELP run (minimal necrosis and mild IRI). Comparison of W40-NELP and W40-Cold revealed greater bile production and oxygen extraction ratio in W40-NELP. In contrast, markers of cellular and functional damage were increased in the W40-Cold group. Conclusion NELP improves metabolic and functional parameters of livers with either short or extended warm ischemia times compared with livers subjected to comparable cold ischemia times.

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