Normothermic Machine Perfusion of Donor Livers Without the Need for Human Blood Products

BACKGROUND: Normothermic machine perfusion (NMP) enables viability assessment of donor livers prior to transplantation. NMP is frequently performed using human blood products including red blood cells (RBC) and fresh frozen plasma (FFP). Our aim was to examine the efficacy of a novel machine perfusion solution based on polymerized bovine hemoglobin HBOC-201.

METHODS: Twenty-four livers declined for transplantation were transported using static cold storage. Upon arrival, livers underwent NMP for 6 hours using pressure-controlled portal and arterial perfusion. Twelve livers were perfused using a solution based on RBCs and FFPs (historical cohort), 6 livers with HBOC-201 and FFPs, and another 6 livers with HBOC-201 and Gelofusine, a gelatin-based colloid solution.

RESULTS: Compared to RBC + FFP perfused livers, livers perfused with HBOC-201 had significantly higher hepatic ATP content, cumulative bile production and portal and arterial flows. Biliary secretion of bicarbonate, bilirubin, bile salts, and phospholipids was similar in all three groups. The ALT concentration in perfusate was lower in HBOC-201 perfused groups.

CONCLUSION: NMP of human donor livers can be performed effectively using HBOC-201 and Gelofusine, eliminating the need for human blood products. Perfusing livers with HBOC-201 is at least similar to perfusion with RBCs and FFPs. Some of the biomarkers of liver function and injury even suggest a possible superiority of an HBOC-201 based perfusion solution and opens a perspective for further optimization of machine perfusion techniques. This article is protected by copyright. All rights reserved.