Ex-situ normothermic machine perfusion (NMP) might minimize ischemia/reperfusion injury (IRI) of liver grafts. Twenty primary liver transplants recipients of older grafts (≥70 years) were randomized 1:1 to NMP or cold storage (CS). The primary study endpoint was to evaluate graft and patient survival at 6 months posttransplantation. The secondary endpoint was to evaluate: IRI by means of peak transaminases within 7 days after surgery; incidence of biliary complications at month 6, and evaluation of liver and bile duct biopsies. Liver and bile duct biopsies were collected at bench surgery, end of ex-situ NMP, and end of transplant surgery. Interleukin 6, 10 and TNF-α perfusate concentrations were tested during NMP. All grafts were successfully transplanted. Median (IQR) posttransplant AST peak was 709 (371-1575) and 574 (377-1162) UI/L, for NMP and CS respectively (p=0.597). One hepatic artery thrombosis in the NMP group and one death in the CS group were observed. In NMP, we observed high TNF-α perfusate levels and these were inversely correlated with lactate (p<0.001). Electron microscopy showed decreased mitochondrial volume density and steatosis, and increased volume density of autophagic vacuoles at the end of transplantation in NMP versus CS patients (p<0.001). Use of NMP with older liver grafts is associated with histological evidence of reduced ischemia/reperfusion injury, although the clinical benefit remains to be demonstrated. This article is protected by copyright. All rights reserved.
Pilot, open, randomized, prospective trial for normothermic machine perfusion evaluation in liver transplantation from older donors.
Ghinolfi D
2019-01-01
Abstract
Ex-situ normothermic machine perfusion (NMP) might minimize ischemia/reperfusion injury (IRI) of liver grafts. Twenty primary liver transplants recipients of older grafts (≥70 years) were randomized 1:1 to NMP or cold storage (CS). The primary study endpoint was to evaluate graft and patient survival at 6 months posttransplantation. The secondary endpoint was to evaluate: IRI by means of peak transaminases within 7 days after surgery; incidence of biliary complications at month 6, and evaluation of liver and bile duct biopsies. Liver and bile duct biopsies were collected at bench surgery, end of ex-situ NMP, and end of transplant surgery. Interleukin 6, 10 and TNF-α perfusate concentrations were tested during NMP. All grafts were successfully transplanted. Median (IQR) posttransplant AST peak was 709 (371-1575) and 574 (377-1162) UI/L, for NMP and CS respectively (p=0.597). One hepatic artery thrombosis in the NMP group and one death in the CS group were observed. In NMP, we observed high TNF-α perfusate levels and these were inversely correlated with lactate (p<0.001). Electron microscopy showed decreased mitochondrial volume density and steatosis, and increased volume density of autophagic vacuoles at the end of transplantation in NMP versus CS patients (p<0.001). Use of NMP with older liver grafts is associated with histological evidence of reduced ischemia/reperfusion injury, although the clinical benefit remains to be demonstrated. This article is protected by copyright. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
