Value of MEGX test in predicting survival after liver transplantation from non-heart-beating donor pigs

Impact of Ig-Therasorb immunoapheresis on stability of xenogeneic ex vivo porcine liver perfusion--value of aminotransferases and flow rates for the assessment of metabolic graft viability

Due to growing shortage of donor organs, the concept of extracorporeal pig liver perfusion in the treatment of acute liver failure has been rediscovered. Immunomodulation, such as immunoapheresis or inhibition of complement, results in long-term perfusion without exact knowledge of the remaining metabolic graft viability. This study was aimed at the comparison of conventional parameters of graft stability such as perfusion rates and release of aminotransferases with parameters of metabolic graft function. Ig-Therasorb immunoapheresis (IA) of the xenogeneic perfusate was performed to protect the discordant pig livers from hyperacute rejection, mediated by preformed naturally occurring human xenogeneic antibodies. The application of IA created stable autologous graft reperfusion after a short time of xenoperfusion, but it was not able to prevent the livers from severe synthetic and functional damage. In the future, improvement of xenogeneic graft function, rather than pure prolongation of perfusion, must be the principal aim.

Effect of warm ischemia time and organ perfusion technique on liver microvascular preservation in a non-heart-beating rat model

BACKGROUND

Current organ shortage has led to a reconsideration of non-heart-beating cadaveric donation.

METHODS

We assessed the effectivity of dual, i.e., arterial and portal-venous versus exclusive, arterial gravity perfusion for procurement of rat livers after 30 min and 60 min of cardiac arrest, analyzing the rate and homogeneity of microvascular perfusion by in situ fluorescence microscopy.

RESULTS

After 30 min of cardiac arrest, a nearly 100% recovery of acinar perfusion with a sinusoidal density not significantly different from that of normal, nonischemic livers was achieved by dual gravity perfusion. Prolongation of cardiac arrest to 60 min caused an almost 50% deficit of acinar and sinusoidal perfusion (P<0.05) with a concomitant 2-3-fold increase of heterogeneity of hepatic microperfusion. Regardless of the warm ischemic time period, dually perfused livers exhibited significantly (P<0.05) higher rates of both acinar and sinusoidal perfusion with increased homogeneity of microcirculation when compared with exclusive arterial perfusion.

CONCLUSION

These data underline the need and benefit of dual perfusion as well as the limitation of warm ischemic tolerance to 30 min for safe liver procurement of non-heart-beating donors.