Machine Perfusion Preservation for Porcine Split Liver Graft
Hiroyuki Takahashi1, Naoto Matsuno1,2, Hiromichi Obara3, Tatsuya Shonaka1, Masahide Otani1,2, Mikako Gouchi1, Mizuho Ohara1, Yuji Nishikawa4, Seisuke Sakamoto5, Mureo Kasahara5, Hiroyuki Furukawa1.
1Gastroenterology and Transplantation, Asahikawa Medical University, Asahikawa, Japan; 2Transplantation technology, Asahikawa Medical University, Asahikawa, Japan; 3Mechanical Engineering, Metropolitan Universityof Tokyo, Tokyo, Japan; 4Pathology, Asahikawa Medical University, Asahikawa, Japan; 5Transplantation Surgery, National Center for Child Health and Development, Tokyo, Japan
Utilization of split liver grafts would greatly contribute to the expansion of the donor organ pool. However, the implementation of such a strategy requires the development of novel preservation methods to recover from severe ischemic reperfusion injury. To assess potential methods and effect, porcine split livers were perfused and evaluated ex vivo isolated liver perfiusion system.
Materials and Methods: Porcine split liver graft was made by 75% liver resection All livers were perfused with newly developed machine perfusion (MP) system. The grafts were perfused for 4 hours with modified UW-gluconate solution. Group 1: Splitting was performed in back table. Grafts were preserved with simple cold storage for 4 hrs. Group 2: Splitting was performed in back table. Then, grafts were preserved with hypothermic perfusion preservation(HMP) for 4hrs. Group 3: Splitting was performed during perfusion preservation. Then, grafts were preserved with HMP. All grafts were evaluated by isolated ex vivo perfusion system with use of diluted autologous blood for 2 hours.
Results: Both of portal vein and hepatic artery pressure was remarkably higher(14,5mmHg ,160.8mmHg respectively) in group 1. Portal resistance showed 0.55vs0.25vs0.01 mmHg/ml/min100gliver in 60min after reperfusion. AST (250 vs 152 vs 52 IU/L/100g liver) and hyaluronic acid level (68 vs72 vs 41 ng/L/100g liver) were also high and increase in 120 min. after reperfusion in group 1.
Conclusion: Potentially, splitting during machine perfusion preservation may help the recovery of function and protect from endothelium injury for split liver transplantation.
