Observations on the ex situ perfusion of livers for transplantation.
Gimson, Alexander E
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
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Watson, C., Kosmoliaptsis, V., Pley, C., Randle, L., Fear, C., Crick, K., Gimson, A. E., et al. (2018). Observations on the ex situ perfusion of livers for transplantation.. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 18 (8), 2005-2020. https://doi.org/10.1111/ajt.14687
Normothermic ex situ liver perfusion might allow viability assessment of livers before transplantation. Perfusion characteristics were studied in 47 liver perfusions, of which 22 resulted in transplants. Hepatocellular damage was reflected in the perfusate transaminase concentrations, which correlated with post-transplant peak transaminase levels. Lactate clearance occurred within 3 hours in 46 of 47 perfusions, and glucose rose initially during perfusion in 44. Three livers required higher levels of bicarbonate support to maintain physiological pH, including one developing primary non-function. Bile production did not correlate with viability or cholangiopathy, but bile pH, measured in 16 of the 22 transplanted livers, identified 3 livers that developed cholangiopathy (peak pH<7.4) from those that did not (pH>7.5). In the 11 research livers where it could be studied, bile pH >7.5 discriminated between the 6 livers exhibiting >50% circumferential stromal necrosis of septal bile ducts and 4 without necrosis; one liver with 25-50% necrosis had a maximum pH 7.46. Liver viability during normothermic perfusion can be assessed using a combination of transaminase release, glucose metabolism, lactate clearance and maintenance of acid-base balance. Evaluation of bile pH may offer a valuable insight into bile duct integrity and risk of post-transplant ischaemic cholangiopathy.
Bile Ducts, Hepatocytes, Humans, Reperfusion Injury, Organ Preservation, Prognosis, Liver Transplantation, Follow-Up Studies, Perfusion, Adult, Middle Aged, Tissue Donors, Tissue and Organ Procurement, Female, Male, Primary Graft Dysfunction, Young Adult, Biomarkers
Department of Health (via National Institute for Health Research (NIHR)) (NIHR BTRU-2014-10027)
WELLCOME TRUST (202077/Z/16/Z)
Embargo Lift Date
External DOI: https://doi.org/10.1111/ajt.14687
This record's URL: https://www.repository.cam.ac.uk/handle/1810/274840
Attribution 4.0 International
Licence URL: http://creativecommons.org/licenses/by/4.0/
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