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Sequential Hypothermic And Normothermic Perfusion Preservation And Transplantation Of Expanded Criteria Donor Livers
*Qiang Liu, *Luca Del Prete, *Giuseppe D'Amico, *Teresa Diago Uso, *Koji Hashimoto, *Federico Aucejo, *Masato Fujiki, *Bijan Eghtesad, *Kazunari Sasaki, *Choon Hyuck David Kwon, *Jacek Cywinski, Charles Miller, Cristiano Quintini
Cleveland Clinic, Cleveland, OH

Objective: To assess safety and feasibility of Sequential hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP) and the potential benefits of graft viability preservation and assessment prior to liver transplantation. Methods: With FDA and IRB approval, seventeen expanded criteria donor (ECD) livers underwent sequential HOPE-NMP using our institutional developed perfusion device. Herein we report the preliminary data. Results: ECD livers included donors after cardiac death (DCD), elder donor, steatosis, hypertransaminasemia, or calcified artery. Perfusion duration ranged between 1-2 hours for the HOPE phase and 4-9 hours for the NMP phase. Three livers were judged to be untransplantable during NMP based on perfusate lactate level, bile production, and macroappearance. One liver was not transplanted because of recipient issue and failed reallocation. Thirteen livers were transplanted, including nine DCD livers (donor warm ischemia time 16-25min) and four livers from donors after brain death (DBD). All these livers had perfusate lactate cleared to <4.0 mmol/L within 3hr NMP. Bile production rate was 0.2-10.7 ml/hr for DBD livers, and 0.3-6.1 ml/hr for DCD livers. After transplantation, five cases had early allograft dysfunction (3 DCDs and 2 DBDs livers). No graft failure or patient death occurred in the follow-up time two weeks to seven months to date. No liver developed ischemic cholangiopathy. Conclusions: Sequential HOPE-NMP preservation is safe and feasible, and has the potential benefits to preserve and evaluate ECD livers.


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