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Ex Situ Liver Machine Perfusion: The Impact of Fresh Frozen Plasma.

Ex Situ Liver Machine Perfusion: The Impact of Fresh Frozen Plasma. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Liu, Q., Hassan, A., Pezzati, D., Soliman, B., Lomaglio, L., Grady, P., Del Angel Diaz, L., Simioni, A., Maikhor, S., Etterling, J., D'Amico, G., Iuppa, G., Diago Uso, T., Hashimoto, K., Aucejo, F., Fujiki, M., Eghtesad, B., Sasaki, K., Kwon, C. H., Cywinski, J., Irefin, S., Bennett, A., Baldwin, W., Miller, C., Quintini, C. 2020; 26 (2): 215-226

Abstract

The primary aim of this single-center, phase 1 exploratory study was to investigate the safety, feasibility, and impact on intrahepatic hemodynamics of a fresh frozen plasma (FFP)-based perfusate in ex situ liver normothermic machine perfusion (NMP) preservation. Using an institutionally developed perfusion device, 21 livers (13 donations after brain death and 8 donations after circulatory death) were perfused for 3 hours 21 minutes to 7 hours 52 minutes and successfully transplanted. Outcomes were compared in a 1:4 ratio to historical control patients matched according to donor and recipient characteristics and preservation time. Perfused livers presented a very low resistance state with high flow during ex situ perfusion (arterial and portal flows 340 ± 150 and 890 ± 70 mL/minute/kg liver, respectively). This hemodynamic state was maintained even after reperfusion as demonstrated by higher arterial flow observed in the NMP group compared with control patients (220 ± 120 versus 160 ± 80 mL/minute/kg liver, P = 0.03). The early allograft dysfunction (EAD) rate, peak alanine aminotransferase (ALT), and peak aspartate aminotransferase (AST) levels within 7 days after transplantation were lower in the NMP group compared with the control patients (EAD 19% versus 46%, P = 0.02; peak ALT 363 ± 318 versus 1021 ± 999 U/L, P = 0.001; peak AST 1357 ± 1492 versus 2615 ± 2541 U/L, P = 0.001 of the NMP and control groups, respectively). No patient developed ischemic type biliary stricture. One patient died, and all other patients are alive and well at a follow-up of 12-35 months. No device-related adverse events were recorded. In conclusion, with this study, we showed that ex situ NMP of human livers can be performed safely and effectively using a noncommercial device and an FFP-based preservation solution. Future studies should further investigate the impact of an FFP-based perfusion solution on liver hemodynamics during ex situ normothermic machine preservation.

View details for DOI 10.1002/lt.25668

View details for PubMedID 31642164