Prolonged preservation of donor livers: the benefits of hypothermic machine perfusion

    Research output: ThesisThesis fully internal (DIV)

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    Abstract

    A major challenge in liver transplantation lies in the short time a donor liver can be kept viable outside the body. Preservation by traditional static cold storage is a simple and effective approach to preserve good quality donor livers, but is associated with a number of limitations, including inevitable ischemia-reperfusion injury and a limited preservation time. Machine perfusion as a novel method of organ preservation facilitates the preservation and optimization of donor organs at variable temperatures. It has been shown that a brief period (2 hours) of hypothermic (4-12°C) oxygenated machine perfusion (HOPE) protects livers against ischemia-reperfusion injury. In this thesis, we investigated whether HOPE could also be used to prolong preservation time. In a preclinical study, we show successful preservation of porcine donor livers up to 24 hours with equivalent hepatobiliary function and injury after reperfusion compared to livers preserved with 2 hours HOPE. The results of a multicenter, retrospective, cohort study show that outcomes after liver transplantation are not compromised when livers are preserved by prolonged (≥4 hours) HOPE with total preservation times up to 21 hours. Finally, a prospective clinical trial was initiated to investigate safety and feasibility of prolonged HOPE in liver transplantation (DHOPE-PRO trial). If the results of this trial confirm prolonged preservation of donor livers by HOPE is safe and feasible, this may have important implications for everyday transplant logistics.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Porte, Robert, Supervisor
    • Lisman, Ton, Supervisor
    • de Meijer, Vincent, Co-supervisor
    • Martins, Paulo N., Co-supervisor, External person
    Award date16-May-2022
    Place of Publication[Groningen]
    Publisher
    DOIs
    Publication statusPublished - 2022

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