PMID- 28437389
DCOM- 20170816
LR  - 20181113
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 101
IP  - 5
DP  - 2017 May
TI  - Normothermic Perfusion in the Assessment and Preservation of Declined Livers
      Before Transplantation: Hyperoxia and Vasoplegia-Important Lessons From the First
      12 Cases.
PG  - 1084-1098
LID - 10.1097/TP.0000000000001661 [doi]
AB  - BACKGROUND: A program of normothermic ex situ liver perfusion (NESLiP) was
      developed to facilitate better assessment and use of marginal livers, while
      minimizing cold ischemia. METHODS: Declined marginal livers and those offered for
      research were evaluated. Normothermic ex situ liver perfusion was performed using
      an erythrocyte-based perfusate. Viability was assessed with reference to
      biochemical changes in the perfusate. RESULTS: Twelve livers (9 donation after
      circulatory death [DCD] and 3 from brain-dead donors), median Donor Risk Index
      2.15, were subjected to NESLiP for a median 284 minutes (range, 122-530 minutes) 
      after an initial cold storage period of 427 minutes (range, 222-877 minutes). The
      first 6 livers were perfused at high perfusate oxygen tensions, and the
      subsequent 6 at near-physiologic oxygen tensions. After transplantation, 5 of the
      first 6 recipients developed postreperfusion syndrome and 4 had sustained
      vasoplegia; 1 recipient experienced primary nonfunction in conjunction with a
      difficult explant. The subsequent 6 liver transplants, with livers perfused at
      lower oxygen tensions, reperfused uneventfully. Three DCD liver recipients
      developed cholangiopathy, and this was associated with an inability to produce an
      alkali bile during NESLiP. CONCLUSIONS: Normothermic ex situ liver perfusion
      enabled assessment and transplantation of 12 livers that may otherwise not have
      been used. Avoidance of hyperoxia during perfusion may prevent postreperfusion
      syndrome and vasoplegia, and monitoring biliary pH, rather than absolute bile
      production, may be important in determining the likelihood of posttransplant
      cholangiopathy. Normothermic ex situ liver perfusion has the potential to
      increase liver utilization, but more work is required to define factors
      predicting good outcomes.
FAU - Watson, Christopher J E
AU  - Watson CJE
AD  - 1 Department of Surgery, Addenbrooke's Hospital, University of Cambridge,
      Cambridge, United Kingdom. 2 The NIHR Cambridge Biomedical Research Centre and
      the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation
      at the University of Cambridge, Cambridge, United Kingdom. 3 Department of
      Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom. 4 Department of
      Pathology, Addenbrooke's Hospital, Cambridge, United Kingdom. 5 Division of
      Perioperative Care, Addenbrooke's Hospital, Cambridge, United Kingdom. 6
      University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital,
      Cambridge, United Kingdom.
FAU - Kosmoliaptsis, Vasilis
AU  - Kosmoliaptsis V
FAU - Randle, Lucy V
AU  - Randle LV
FAU - Gimson, Alexander E
AU  - Gimson AE
FAU - Brais, Rebecca
AU  - Brais R
FAU - Klinck, John R
AU  - Klinck JR
FAU - Hamed, Mazin
AU  - Hamed M
FAU - Tsyben, Anastasia
AU  - Tsyben A
FAU - Butler, Andrew J
AU  - Butler AJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cold Ischemia
MH  - *Donor Selection
MH  - Follow-Up Studies
MH  - Humans
MH  - Hyperoxia/*etiology/prevention & control
MH  - Liver Transplantation/*methods
MH  - Middle Aged
MH  - Outcome Assessment (Health Care)
MH  - Perfusion/adverse effects/*methods
MH  - Postoperative Complications/*etiology/prevention & control
MH  - Vasoplegia/*etiology/prevention & control
MH  - Warm Ischemia/adverse effects/*methods
PMC - PMC5642347
EDAT- 2017/04/25 06:00
MHDA- 2017/08/17 06:00
CRDT- 2017/04/25 06:00
PHST- 2017/04/25 06:00 [entrez]
PHST- 2017/04/25 06:00 [pubmed]
PHST- 2017/08/17 06:00 [medline]
AID - 10.1097/TP.0000000000001661 [doi]
AID - 00007890-201705000-00031 [pii]
PST - ppublish
SO  - Transplantation. 2017 May;101(5):1084-1098. doi: 10.1097/TP.0000000000001661.