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Meszaros AT, Hofmann J, Buch ML, Cardini B, Dunzendorfer-Matt T, Nardin F, Blumer MJ, Fodor M, Hermann M, Zelger B, Otarashvili G, Schartner M, Weissenbacher A, Oberhuber R, Resch T, Troppmair J, Öfner D, Zoller H, Tilg H, Gnaiger E, Hautz T, Schneeberger S. Mitochondrial respiration during normothermic liver machine perfusion predicts clinical outcome. EBioMedicine 2022; 85:104311. [PMID: 36374770 PMCID: PMC9626552 DOI: 10.1016/j.ebiom.2022.104311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Reliable biomarkers for organ quality assessment during normothermic machine perfusion (NMP) are desired. ATP (adenosine triphosphate) production by oxidative phosphorylation plays a crucial role in the bioenergetic homeostasis of the liver. Thus, detailed analysis of the aerobic mitochondrial performance may serve as predictive tool towards the outcome after liver transplantation. Methods In a prospective clinical trial, 50 livers were subjected to NMP (OrganOx Metra) for up to 24 h. Biopsy and perfusate samples were collected at the end of cold storage, at 1 h, 6 h, end of NMP, and 1 h after reperfusion. Mitochondrial function and integrity were characterized by high-resolution respirometry (HRR), AMP, ADP, ATP and glutamate dehydrogenase analysis and correlated with the clinical outcome (L-GrAFT score). Real-time confocal microscopy was performed to assess tissue viability. Structural damage was investigated by histology, immunohistochemistry and transmission electron microscopy. Findings A considerable variability in tissue viability and mitochondrial respiration between individual livers at the end of cold storage was observed. During NMP, mitochondrial respiration with succinate and tissue viability remained stable. In the multivariate analysis of the 35 transplanted livers (15 were discarded), area under the curve (AUC) of LEAK respiration, cytochrome c control efficiency (mitochondrial outer membrane damage), and efficacy of the mitochondrial ATP production during the first 6 h of NMP correlated with L-GrAFT. Interpretations Bioenergetic competence during NMP plays a pivotal role in addition to tissue injury markers. The AUC for markers of outer mitochondrial membrane damage, ATP synthesis efficiency and dissipative respiration (LEAK) predict the clinical outcome upon liver transplantation. Funding This study was funded by a Grant from the In Memoriam Dr. Gabriel Salzner Stiftung awarded to SS and the 10.13039/501100009968Tiroler Wissenschaftsfond granted to TH.
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Key Words
- liver
- transplantation
- normothermic machine perfusion
- mitochondria
- high-resolution respirometry
- adp, adenosine diphosphate
- alt, alanine aminotransferase
- amp, adenosine monophosphate
- ast, aspartate aminotransferase
- atp, adenosine triphosphate
- auc, area under the curve
- bmi, body mass index
- ccasp3, cleaved caspase 3
- dbd, donation after brain death
- dcd, donation after cardiocirculatory death
- dri, donor risk index
- ead, early allograft dysfunction
- ecd, extended criteria donor
- et, electron transfer
- fao, fatty acid oxidation
- fcr, flux control ratio
- fmn, flavin mononucleotide
- gldh, glutamate dehydrogenase
- h&e, haematoxylin and eosin
- hope, hypothermic oxygenated machine perfusion
- hrr, high-resolution respirometry
- ihc, immunohistochemistry
- il-6, interleukin 6
- iri, ischemia-reperfusion injury
- ldh, lactate dehydrogenase
- l-graft, liver graft assessment following transplantation
- lt, liver transplantation
- meaf, model for early allograft function
- meld, model of end stage liver disease
- mp, machine perfusion
- mtim, mitochondrial inner membrane
- mtom, mitochondrial outer membrane
- nafld, non-alcoholic fatty liver disease
- nmp, normothermic machine perfusion
- oxphos, oxidative phosphorylation
- pi, propidium iodidide
- rtcm, real-time confocal microscopy
- scs, static cold storage
- sd, standard deviation
- suit, substrate-uncoupler-inhibitor titration
- tem, transmission electron microscopy
- tlr4, toll-like receptor 4
- tnfα, tumor necrosis factor alpha
- wga, wheat germ agglutinin
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Affiliation(s)
- Andras T. Meszaros
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Hofmann
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Madita L. Buch
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Florian Nardin
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria,Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael J. Blumer
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Margot Fodor
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hermann
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Giorgi Otarashvili
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Schartner
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Resch
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Troppmair
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Theresa Hautz
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, organLife™ Laboratory and Daniel Swarovski Research Laboratory, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria,Corresponding author. Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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