This journal is
indexed in Scopus
Year 2014 Vol. 22 No 1
A.E. SHCHERBA, S.V. KOROTKOV, O.A. LEBEDZ, M.M. SAUCHUK, À.M. DZYADZKO, À.F. MINOU, E.O. SANTOCKY, Î.O. RUMMO
EXPERIMENTAL HYPOTHERMIC MACHINE PERFUSION OF LIVER GRAFTS BY CUSTODIOL HTK SOLUTION
Republican Scientific and Practical Center “Organs and Tissues Transplantation”,
ME “The 9th City Clinical Hospital”, Minsk 1,
SEE “Belarusian Medical Academy of Postgraduate Education” 2,
ME “City Clinical Pathoanatomical Bureau”, Minsk3,
The Republic of Belarus
Objectives. To define experimentally the efficiency and safety of the hypothermic machine perfusion of the liver grafts with Custodiol HTK preservation solution.
Methods. The study was carried out on five donor organs taken from donors with deceased brain, beating heart and with liver recognized to be non-transplantable according to some factors by the donor team. The apparatus of artificial blood circulation was used as a pump. The circuit of the solution circulation was open with free outflow from the inferior vena cava. Solution perfusion was performed through portal vein only, the intake – from the container with the organ located. The left portal vein was clamped to prevent machine perfusion and continuation of a static cold preservation of the left liver lobe. The intake of effluent from the hepatic veins for a biochemical analysis as well as the biopsy of both liver lobes was performed for efficacy estimation.
Results. It has been established that the machine perfusion leads to more profound liver hypothermia two hours after the beginning of perfusion. The another important aspect is considered as a reliable reduction of cytolytic markers expression maximum for two hours. The machine perfusion contributed to the reliable reduction of AST and LDH from the perfused lobe with respect to the initial value. Wherein the values of AST, LDH and ALT in a static cold preservation lobe have not changed reliably comparing to the initial value. Moreover a double reduction of level of necrosis and apoptosis in the perfused lobe was registered in comparison with a static cold preserved lobe after eleven-hours machine perfusion.
Conclusions. The application of hypothermic machine liver perfusion with Custodiol HTK solution with approximated to physiological flow parameters leads to decrease of AST and ALT levels and lactic acidosis. Moreover it associated with reduction of necrosis and apoptosis of hepatocytes in comparison with a static cold liver preservation.
- Ohkohchi N. Mechanisms of preservation and ischemic/reperfusion injury in liver transplantation. Transplant Proc. 2002 Nov;34(7):2670–3.
- Briceno J, Marchal T, Padillo J, Solorzano G, Pera C.Influence of marginal donors on liver preservation injury. Transplantation. 2002 Aug 27;74(4):522–6.
- Bussutil RW, Klintmalm GK. Transplantation of the liver. Elsevier; 2005. 186 p.
- Monbaliu D, Brassil J, Heedfeld V, et al. Comparison of cold storage versus hypothermic machine perfusion in a preclinical model of liver transplantation. Transplantation. 2006; 82(1)(suppl 3): 90-91.
- Olschewski P, Gass P, Ariyakhagorn V, Jasse K, Hunold G, Menzel M, Schoning W, Schmitz V, Neuhaus P, Puhl G. The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers.Cryobiology. 2010 Jun;60(3):337–43.
- Vekemans K, Liu Q, Pirenne J, Monbaliu D.Artificial circulation of the liver: machine perfusion as a preservation method in liver transplantation. AnatRec (Hoboken). 2008 Jun;291(6):735-40.
- Monbaliu D, Brassil J. Machine perfusion of the liver: past, present and future. Curr Opin Organ Transplant. 2010 Apr;15(2):160–6.
- Hart NA, van der Plaats A, Leuvenink HG, van Goor H, Wiersema-Buist J, Verkerke GJ, Rakhorst G, Ploeg RJ. Hypothermic machine perfusion of the liver and the critical balance between perfusion pressures and endothelial injury.Transplant Proc. 2005 Jan-Feb;37(1):332–4.
- Guarrera JV, Henry SD, Samstein B, Odeh-Ramadan R, Kinkhabwala M, Goldstein MJ, Ratner LE, Renz JF, Lee HT, Brown RS Jr, Emond JC. Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transplant. 2010 Feb;10(2):372-81.
- Stegemann J, Hirner A, Rauen U, Minor T. Use of a new modified HTK solution for machine preservation of marginal liver grafts.J Surg Res. 2010 May 1;160(1):155–62.
- Matsuoka L, Shah T, Aswad S, Bunnapradist S, Cho Y, Mendez RG, Mendez R, Selby R. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant. 2006 Jun;6(6):1473–8.
- Dutkowski P, Odermatt B, Heinrich T, Schonfeld S, Watzka M, Winkelbach V, Krysiak M, Junginger T. Hypothermic oscillating liver perfusion stimulates ATP synthesis prior to transplantation. J Surg Res. 1998 Dec;80(2):365–72.
- Monbaliu D, Liu Q, Libbrecht L, De Vos R, Vekemans K, Debbaut C, Detry O, Roskams T, van Pelt J, Pirenne J. Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. LiverTranspl. 2012 Dec;18(12):1495-507.
220116, Respublika Belarus', g. Minsk, ul. Semashko, d. 8, RNPTs «Transplantatsii organov i tkanei», UZ «9-ia gorodskaia klinicheskaia bol'nitsa», otdel transplantologii.
e-mail: max.sauchuk @ mail.ru,
Sauchuk Maxim Mikhailovich
Shcherba A.E. PhD, an associate professor, a head of the transplantation department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Korotkov S.V. PhD, an associate professor, a head of the 1st surgical department of ME “The 9th City Clinical Hospital”, Minsk.
Lebedz O.A. A pathologist of ME “City Clinical Pathoanatomical Bureau”, Minsk. Savchuk M.M. A post-graduate student of the transplantation chair, SEE “Belarusian Medical Academy of Postgraduate Education”.
Dzyadzko A.M. PhD, an associate professor, a head of the anesthesia and reanimation department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Minov A.F. A head of the anesthesia department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Santocky E.O. A head of the anesthesia and reanimation department ¹2 of ME “The 9th City Clinical Hospital”, Minsk.
Rummo O.O. MD, an associate professor, a head of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.