Feasibility of Hypothermic Liver Perfusion

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DESCRIPTION (provided by applicant): More than 43,000 Americans die each year from liver disease, making it the 10th leading disease- related cause of death in the US. Cirrhosis with irreversible injury and scarring of the liver, is the most prevalent cause of liver failure and is attributable to alcohol abuse as well as hepatitis. Although alcohol has been the primary cause of cirrhosis, the Center for Disease Control has predicted that hepatitis-related deaths will increase to 38,000 a year unless improved treatments are developed. The shortage of organs for transplantation continues to be a major impediment to providing optimal treatment for patients with end stage liver failure. There is no dialysis-equivalent therapy for these patients and the prospect of death while waiting for a transplantable organ is a realistic probability. The long-term goal of this SBIR proposal is to increase the number and quality of donor livers available for transplantation by developing a clinically usable, portable, hypothermic perfusion method of liver preservation that will reliably preserve human livers for at least 24 hours. The objective of this Phase I proposal is to test and determine feasibility of an intermediate temperature, 12-14oC, hypothermic oxygenated perfusion strategy in combination with a prototype liver transport device for preservation of porcine heart beating donor liver functions for 24 hours. The prototype liver transport device will be subjected to design review to optimize its design during the course of these experiments. The experimental livers will be compared with fresh untreated controls and livers perfused at 4-6oC under otherwise identical conditions. Both fresh controls and control and experimental hypothermic perfusion groups will be assessed by oxygenated blood perfusion in vitro at 37oC. This normothermic perfusion test circuit will include the liver transport device with additional heat exchange capacity and an oxygenator. During in vitro testing blood gases will be analyzed and both bile and perfusate samples will be collected at frequent intervals. Electrolytes, factor V, ammonia, urea, fibrinogen, hyaluronic acid, indocyanine green clearance and liver enzymes will be assessed in the perfusate or bile samples, as appropriate. If we are successful in this Phase I feasibility study, we will subsequently propose a Phase II study in which porcine liver preservation for 48 hours is attempted and in vitro and in vivo testing is combined with perfusion solution optimization. Forty-eight hours of porcine liver preservation would provide preclinical safety and efficacy data to support progression, with FDA permission, to clinical studies of human livers for up to 24 hours of preservation. PUBLIC HEALTH RELEVANCE: This proposal aims at technical breakthroughs with the potential to address critical national needs for transplantable livers. Conservatively the availability of longer term liver preservation strategies post-mortem may generate significant numbers, equivalent to ~25% more transplantable livers, from expanded criteria heart beating donors and short-term warm ischemic non-heart beating donors.