Predictor Parameters of Liver Viability During Porcine Nomothermic Ex-Situ Liver Perfusion in a Model of Liver Transplantation with Marginal Grafts.

Normothermic ex-situ liver perfusion(NEsLP) offers the opportunity to assess biomarkers of graft function and injury. We investigated NEsLP parameters(biomarkers and markers) for the assessment of liver viability in a porcine transplantation model. Grafts from heart beating donors(HBD), and from donors with 30'(DCD30'), 70'(DCD70') and 120'(DCD120') of warm ischemia were studied. The HBD, DCD30' and DCD70'-groups had 100% survival. In contrast, 70% developed primary non-function(PNF) and died in the DCD120'-group. Hepatocellular function during NEsLP showed low lactate(≤1.1mmol/L) in all the groups except the DCD120'-group(>2mmol/L) at 4hr of perfusion(p=0.04). The fold-urea increase was significantly lower in the DCD120'-group(≤0.4) compared to the other groups(≥0.65)(p=0.01). As for cholangiocyte function, bile/perfusate glucose-ratio was significantly lower(<0.6) in all the groups but the DCD120'-group(≥0.9) after 3hr of perfusion(<0.01). Bile/perfusate Na+ ratio was significantly higher(≥1.2) after 3hr of perfusion in all the groups except for the DCD120'-group(≤1)(p<0.01). Three hours after transplantation, the DCD120'-group had a significantly higher INR(>5) compared to the rest of the groups(≤1.9)(p=0.02). Rocuronium levels were higher at all the time-points in the animals that developed PNF during NEsLP and after transplantation. This study demonstrates that biomarkers and markers of hepatocellular and cholangiocyte function during NEsLP correlate with the degree of ischemic injury and post-transplant function. This article is protected by copyright. All rights reserved.