Ex Situ Machine Perfusion of Human Donor Livers via the Surgically Reopened Umbilical Vein: A Proof of Concept

Transplantation
Otto B van LeeuwenVincent E de Meijer

Abstract

Machine perfusion of donor livers is typically performed via the portal vein main stem. Instead, cannulation of a reopened umbilical vein could allow machine perfusion during organ procurement and subsequent implantation in the recipient without interruption of the portal venous circulation. We aimed to assess the feasibility of portal venous machine perfusion via the umbilical vein. During back table inspection of 5 human livers declined for transplantation, the umbilical vein was surgically reopened, dilated, and cannulated. Hypothermic and normothermic oxygenated machine perfusion (NMP) were performed using the umbilical vein for portal inflow. Three livers were perfused with hypothermic machine perfusion, 1 full liver graft underwent NMP for 4 hours, and 1 left lateral split procedure was performed under continuous NMP with portal perfusion via the umbilical vein. In all livers, access to the portal venous system via the umbilical vein was successfully achieved with good portal flows and macroscopically homogeneous perfusion. The full liver graft that underwent NMP via the umbilical vein for 4 hours showed good lactate clearance, normalized pH, and achieved good bile production with pH >7.55. During the split procedure unde...Continue Reading

References

Nov 26, 2008·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·François DurandJacques Belghiti
Nov 12, 2017·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Xiaoshun HeJiefu Huang
Dec 28, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Alix P M MattonRobert J Porte
Apr 17, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Otto B van LeeuwenRobert J Porte
Nov 10, 2018·Journal of Hepatology·Vincent Erwin de MeijerRobert Jack Porte

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Citations

Jun 20, 2020·Seminars in Liver Disease·E Bonaccorsi-RianiP N Martins
Jun 4, 2020·Annals of Gastroenterological Surgery·Masahiro OhiraHideki Ohdan
Jan 8, 2021·Langenbeck's Archives of Surgery·Vasudevan BaskaranRamanathan Saranga Bharathi
Feb 9, 2021·Transplantation Direct·Adam M ThorneVincent E de Meijer
May 18, 2020·International Journal of Surgery·Paulo N MartinsCristiano Quintini

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