Normothermic machine perfusion of donor livers without the need for human blood products

Alix P.M. Matton, Laura C. Burlage, Rianne van Rijn, Yvonne de Vries, Shanice A. Karangwa, Maarten W. Nijsten, Annette S.H. Gouw, Janneke Wiersema-Buist, Jelle Adelmeijer, Andrie C. Westerkamp, Ton Lisman, Robert J. Porte*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

84 Citations (Scopus)
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Abstract

Normothermic machine perfusion (NMP) enables viability assessment of donor livers prior to transplantation. NMP is frequently performed by using human blood products including red blood cells (RBCs) and fresh frozen plasma (FFP). Our aim was to examine the efficacy of a novel machine perfusion solution based on polymerized bovine hemoglobin-based oxygen carrier (HBOC)-201. Twenty-four livers declined for transplantation were transported by using static cold storage. Upon arrival, livers underwent NMP for 6 hours using pressure-controlled portal and arterial perfusion. A total of 12 livers were perfused using a solution based on RBCs and FFPs (historical cohort), 6 livers with HBOC-201 and FFPs, and another 6 livers with HBOC-201 and gelofusine, a gelatin-based colloid solution. Compared with RBC + FFP perfused livers, livers perfused with HBOC-201 had significantly higher hepatic adenosine triphosphate content, cumulative bile production, and portal and arterial flows. Biliary secretion of bicarbonate, bilirubin, bile salts, and phospholipids was similar in all 3 groups. The alanine aminotransferase concentration in perfusate was lower in the HBOC-201–perfused groups. In conclusion, NMP of human donor livers can be performed effectively using HBOC-201 and gelofusine, eliminating the need for human blood products. Perfusing livers with HBOC-201 is at least similar to perfusion with RBCs and FFP. Some of the biomarkers of liver function and injury even suggest a possible superiority of an HBOC-201–based perfusion solution and opens a perspective for further optimization of machine perfusion techniques. Liver Transplantation 24 528–538 2018 AASLD.

Original languageEnglish
Pages (from-to)528-538
Number of pages11
JournalLiver Transplantation
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 2018
Externally publishedYes

Bibliographical note

Funding Information:
This study was partially financially supported by HbO2 Therapeutics LLC, Souderton, PA. A Van Walree research grant was obtained from the Dutch Koninklijke Nederlandse Akademie van Wetenschappen (KNAW); a research grant was obtained from Tekke Huizinga Fonds, Groningen, the Netherlands; and a research grant was obtained from Stichting de Cock – Hadders, the Netherlands. HbO2 Therapeutics LLC was not involved in any of the data analyses or writing of the present article.

Publisher Copyright:
© 2017 The Authors. Liver Transplantation published by Wiley Periodicals, Inc. on behalf of American Association for the Study of Liver Diseases.

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