Usefulness of preservation by machine perfusion of liver grafts from non-heart-beating donors-A porcine model

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The shortage of organ donors is an universal problem. We report in this study usefulness of preservation method by machine perfusion and pentoxifylline (POF) on the liver transplantation from non-heart-beating (NHB) donor after the shock state.We carried out orthotopic liver transplantation (OUT) using pigs. The liver was harvested from NHB donor after 60 minutes of shock state. The grafts were preserved for 120 minutes by simple cold storage (4゜C, UW solution), or by continuous machine perfusion (8゜C, modified Belzer's gluconate solution). Experimental groups are as follows ; group I (n=4) : simple cold storage, group II (n=5) : non plusatile machine perfusion at 8 mmHg of portal vein pressure, group III (n=5) : non pulsatile machine perfusion at 60 mmHg of hepatic artery pressure, group IV (n=8) : non pulsatile machine perfusion at 60 mmHg of hepatic artery pressure with POF 1 g/L, group V (n=7) : non plusatile machine perfusion at 30 mmHg of hepatic artery pressure, group IV (n=7) : … More plusatile machine perfusion at 30 mmHg of hepatic artery pressure.The survival, blood chemistry and histological changes were compared among these groups. The survival rates at 48 hours were 25% in group I, 20% in group II, 20% in group III, 63% in group IV, 57.1% in group V, 0% in group VI. Postoperative transaminase and hyaluronic acid levels in perfusion groups, especially in group IV, V were lower than those in simple cold storage group. Arterial keton body ratio was higher in perfusion groups. Histological study revealed that the damage of hepatocytes was minimam in perfusion groups especially in group IV and V, but the sinusoidal congestion in perfusion groups tends to be severe than that in simple cold storage group. Electoron microscopic study showed that endothelial cells of sinusoid in group V were severely injured. Nonpulsatile machine perfusion preservation via the hepatic artery is more effective than pulsatile preservation in OLT from the NHB donor with shock. Machine perfusion preservation though hepatic artery with POF allows the optimum graft condition in liver transplantation from NHB donor. Less