Transient cold storage prior to normothermic liver perfusion may facilitate adoption of a novel technology.
Ceresa CDL., Nasralla D., Watson CJE., Butler AJ., Coussios CC., Crick K., Hodson L., Imber C., Jassem W., Knight SR., Mergental H., Ploeg RJ., Pollok JM., Quaglia A., Shapiro AMJ., Weissenbacher A., Friend PJ.
INTRODUCTION: Clinical adoption of normothermic machine perfusion (NMP) may be facilitated by simplifying logistics and reducing costs. This can be achieved by cold storage of livers for transportation to recipient centres before commencing NMP. The purpose of this study was to assess the safety and feasibility of post-static cold storage NMP (pSCS-NMP) in liver transplantation. MATERIALS AND METHODS: In this multi-centre prospective study, 31 livers were transplanted. The primary endpoint was 30-day graft survival. Secondary endpoints included: peak post-transplant aspartate aminotransferase (AST), early allograft dysfunction (EAD), post-reperfusion syndrome (PRS), adverse events, critical care and hospital stay, biliary complications and 12-month graft survival. RESULTS: Thirty-day graft survival was 94%. Livers were preserved for a total of 14 h 10 min ± 4 h 46 min; this included 6 h 1 min ± 1 h 19 min of SCS before 8 h 24 min ± 4 h 4 min of NMP. Median peak serum AST in the first 7 days postoperatively was 457 U/L (92 - 8669 U/L) and 4 livers (13%) developed EAD. PRS was observed in 3 (10%) livers. The median duration of initial critical care stay was 3 (1 - 20) days and median hospital stay was 13 (7 - 31) days. Seven patients (23%) developed complications of grade IIIb severity or above and 2 (6%) patients developed biliary complications; one bile leak and one anastomotic stricture with no cases of ischaemic cholangiopathy. Twelve-month overall graft survival (including death with a functioning graft) was 84%. CONCLUSION: This study demonstrates that pSCS-NMP was feasible and safe which may facilitate clinical adoption. This article is protected by copyright. All rights reserved.