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Am J Transplant. 2016 Jan;16(1):353-7. doi: 10.1111/ajt.13448. Epub 2015 Sep 22.

Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death.

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Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
The Liver Unit, University Hospital, Birmingham, UK.


Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57-year-old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life-supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma-free red cell-based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia.


Preimplant ex situ normothermic liver perfusion; donation after circulatory death; liver transplantation

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