The liver is one of the most essential organs, and transplantation is an established treatment for patients with end-stage disease who have lost their liver function. However, organ shortage is a critical problem in transplantation; thus, the development of an innovative preservation system to adopt critical grafts obtained from extended criteria donors or donation after cardiac death donors as viable organs for transplantation is necessary. We recently developed a novel rewarming machine perfusion preservation system for liver transplantation, and herein discuss this system, which allows the perfusion temperature to be controlled during the transition from hypothermic to subnormothermic conditions. This system has two functions: (1) the preservation and recovery of organ function and (2) screening the organ for viability. To achieve these functions, this system has three features: (1) temperature control of the preservation perfusate and liver graft, (2) dual-controlled perfusion of the portal vein and hepatic artery, and (3) real-time monitoring of the perfusion conditions, including the flow rate, perfusion pressure and temperature. This system was useful for liver preservation and for evaluating the graft viability and recovery of functions during machine perfusion before transplantation. This novel rewarming machine preservation system was tested in an experimental model using porcine liver grafts. We report that this system has certain advantages in liver preservation, and believe that this system will positively contribute to the expansion of the organ donor pool.

References

1.
Talbot
,
D.
, and
D'Alessandro
,
A. M.
,
2009
,
Organ Donation and Transplantation After Cardiac Death
,
Oxford University
,
New York
, Chap. 13.
2.
Ciria
,
R.
,
Briceno
,
J.
,
Rufian
,
S.
,
Luque
,
A.
, and
Lopez-Cillero
,
P.
,
2012
, “
Donation After Cardiac Death: Where, When, and How?
Transplant. Proc.
,
44
(
6
), pp.
1470
1474
.10.1016/j.transproceed.2012.05.003
3.
Monbaliu
,
D.
,
Pirenne
,
J.
, and
Talbot
,
D.
,
2012
, “
Liver Transplantation Using Donation After Cardiac Death Donors
,”
J. Hepatol.
,
56
(
2
), pp.
474
485
.10.1016/j.jhep.2011.07.004
4.
St. Peter
,
S. D.
,
Imber
,
C. J.
, and
Friend
,
P. J.
,
2002
, “
Liver and Kidney Preservation by Perfusion
,”
Lancet
,
359
(
9306
), pp.
604
613
.10.1016/S0140-6736(02)07749-8
5.
Dutkowski
,
P.
,
de Rougemont
,
O.
, and
Clavien
,
P.
,
2008
, “
Machine Perfusion for ‘Marginal’ Liver Grafts
,”
Am. J. Transplant.
,
8
(
5
), pp.
917
924
.10.1111/j.1600-6143.2008.02165.x
6.
Vekemans
,
K.
,
Liu
,
Q.
,
Pirenne
,
J.
, and
Monbaliu
,
D.
,
2008
, “
Artificial Circulation of the Liver: Machine Perfusion as a Preservation Method in Liver Transplantation
,”
Anat. Rec.
,
291
(
6
), pp.
735
740
.10.1002/ar.20662
7.
Yuan
,
X.
,
Theruvath
,
A. J.
,
Ge
,
X.
,
Floerchinger
,
B.
,
Jurisch
,
A.
,
García-Cardeña
,
G.
, and
Tullius
,
S. G.
,
2010
, “
Machine Perfusion or Cold Storage in Organ Transplantation: Indication, Mechanisms, and Future Perspectives
,”
Transpl. Int.
,
23
(
6
), pp.
561
570
.10.1111/j.1432-2277.2009.01047.x
8.
Moers
,
C.
,
Smits
,
J. M.
,
Maathuis
,
M.-H. J.
,
Treckmann
,
J.
,
van Gelder
,
F.
,
Napieralski
,
B. P.
,
van Kasterop-Kutz
,
M.
,
van der Heide
,
J. J. H.
,
Squifflet
,
J.-P.
,
van Heurn
,
E.
,
Kirste
,
G. R.
,
Rahmel
,
A.
,
Leuvenink
,
H. G. D.
,
Paul
,
A.
,
Pirenne
,
J.
, and
Ploeg
,
R. J.
,
2009
, “
Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation
,”
N. Engl. J. Med.
,
360
, pp.
7
19
.10.1056/NEJMoa0802289
9.
Moers
,
C.
,
Pirenne
,
J.
,
Paul
,
A.
, and
Ploeg
,
R. J.
,
2012
, “
Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation
,”
N. Engl. J. Med.
,
366
(
8
), pp.
770
771
.10.1056/NEJMc1111038
10.
Pienaar
,
B. H.
,
Lindell
,
S. L.
,
Van Gulik
,
T.
,
Southard
,
J. H.
, and
Belzer
,
F. O.
,
1990
, “
Seventy-Two-Hour Preservation of the Canine Liver by Machine Perfusion
,”
Transplantation
,
49
,
258
260
.10.1097/00007890-199002000-00005
11.
Kozaki
,
K.
,
Uchiyama
,
M.
,
Nemoto
,
T.
,
Degawa
,
H.
,
Takeuchi
,
H.
,
Matsuno
,
N.
,
Sakurai
,
E.
,
Kozaki
,
M.
, and
Nagao
,
T.
,
1997
, “
Usefulness of a Combination of Machine Perfusion and Pentoxifylline for Porcine Liver Transplantation From Non-Heart-Beating Donors With Prolonged Hypotension
,”
Transplant. Proc.
,
29
(
8
), pp.
3476
3477
.10.1016/S0041-1345(97)00986-X
12.
Guarrera
,
J. V.
,
Estevez
,
J.
,
Boykin
J.
,
Boyce
,
R.
,
Rashid
,
J.
,
Sun
,
S.
, and
Arrington
,
B.
,
2005
, “
Hypothermic Machine Perfusion of Liver Grafts for Transplantation: Technical Development in Human Discard and Miniature Swine Models
,”
Transplant. Proc.
,
37
(
1
), pp.
323
325
.10.1016/j.transproceed.2004.12.094
13.
Plaats
,
A.′T.
,
Hart
,
N. A.
,
Verkerke
,
G. J.
,
Leuvenink
,
H. G. D.
,
Ploeg
,
R. J.
, and
Rakhorst
,
G.
,
2004
, “
Hypothermic Machine Preservation in Liver Transplantation Revisited: Concepts and Criteria in the New Millennium
,”
Ann. Biomed. Eng.
,
32
(
4
), pp.
623
631
.10.1023/B:ABME.0000019181.18194.51
14.
Plaats
,
A.
, and
Maathuis
,
M.
,
2006
, “
The Groningen Hypothermic Liver Perfusion Pump: Functional Evaluation of a New Machine Perfusion System
,”
Ann. Biomed. Eng.
,
34
(
12
), pp.
1924
1934
.10.1007/s10439-006-9207-4
15.
Monbaliu
,
D.
,
Vekemans
,
K.
,
De Vos
,
R.
,
Brassil
,
J.
,
Heedfeld
,
J.
,
Qiang
,
L.
,
D'hollander
,
M.
,
Roskams
,
T.
, and
Pirenne
,
J.
,
2007
, “
Hemodynamic, Biochemical, and Morphological Characteristics During Preservation of Normal Porcine Livers by Hypothermic Machine Perfusion
,”
Transplant. Proc.
,
39
(
8
), pp.
2652
2658
.10.1016/j.transproceed.2007.08.009
16.
Dutkowski
,
P.
,
Furrer
,
K.
,
Tian
,
Y.
,
Graf
,
R.
, and
Clavien
,
P.-A.
,
2006
, “
Novel Short-Term Hypothermic Oxygenated Perfusion (HOPE) System Prevents Injury in Rat Liver Graft From Non-Heart Beating Donor
,”
Ann. Surg.
,
244
(
6
), pp.
968
977
.10.1097/01.sla.0000247056.85590.6b
17.
Shigeta
,
T.
,
Matsuno
,
N.
,
Huai-Che
,
H.
,
Obara
,
H.
,
Mizunuma
,
H.
,
Hirano
,
T.
,
Uemoto
,
S.
, and
Enosawa
,
S.
,
2012
, “
A Basic Consideration for Porcine Liver Preservation Using a Novel Continuous Machine Perfusion Device
,”
Transplant. Proc.
,
44
(
4
), pp.
942
945
.10.1016/j.transproceed.2012.03.013
18.
Guarrera
,
J. V.
,
Henry
,
S. D.
,
Samstein
,
B.
,
Odeh-Ramadan
,
R.
,
Kinkhabwala
,
M.
,
Goldstein
,
M. J.
,
Ratner
,
L. E.
,
Renz
,
J. F.
,
Lee
,
H. T.
,
Brown
,
R. S.
, and
Emond
,
J. C.
,
2010
, “
Hypothermic Machine Preservation in Human Liver Transplantation: The First Clinical Series
,”
Am. J. Transplant.
,
10
(
2
), pp.
372
381
.10.1111/j.1600-6143.2009.02932.x
19.
Naruse
,
K.
,
Sakai
,
Y.
,
Guo
L.
,
Natori
,
T.
,
Shindoh
,
T.
,
Karasawa
,
Y.
,
Iida
,
Y.
,
Kojima
,
K.
,
Michishita
,
K.
, and
Makuuchi
,
M.
,
2003
, “
Development of a New Extracorporeal Whole-Liver Perfusion System
,”
Int. J. Artif. Organs
,
6
(
3
), pp.
211
217
.10.1007/s10047-003-0225-9
20.
Tolboom
,
H.
,
Pouw
,
R.
,
Uygun
,
K.
,
Tanimura
,
Y.
,
Izamis
,
M.-L.
,
Berthiaume
,
F.
, and
Yarmush
,
M. L.
,
2007
, “
A Model for Normothermic Preservation of the Rat Liver
,”
Tissue Eng.
,
13
(
8
), pp.
2143
2151
.10.1089/ten.2007.0101
21.
Fondevila
,
C.
,
Hessheimer
,
A. J.
,
Maathuis
,
M.-H. J.
,
Muñoz
,
J.
,
Taurá
,
P.
,
Calatayud
,
D.
,
Leuvenink
,
H.
,
Rimola
,
A.
,
Ploeg
,
R. J.
, and
García-Valdecasas
,
J. C.
,
2011
, “
Superior Preservation of DCD Livers With Continuous Normothermic Perfusion
,”
Ann. Surg.
,
254
(
6
), pp.
1000
1007
.10.1097/SLA.0b013e31822b8b2f
22.
Tolboom
,
H.
,
Izamis
M.-L.
,
Sharma
,
N.
,
Milwid
,
J. M.
,
Sc
,
M.
,
Uygun
,
K.
, and
Yarmush
,
M. L.
,
2011
, “
Subnormothermic Machine Perfusion at Both 20 °C and 30 °C Recovers Ischemic Rat Livers for Successful Transplantation
,”
J. Surg. Res.
,
8
, pp.
1
8
.10.1016/j.jss.2011.03.003
23.
Olschewski
,
P.
,
Gass
,
P.
,
Ariyakhagorn
,
V.
,
Jasse
,
K.
,
Hunold
,
G.
,
Menzel
,
M.
,
Schoning
,
W.
,
Schmitz
,
V.
,
Neuhaus
,
P.
, and
Puhl
,
G.
,
2010
, “
The Influence of Storage Temperature During Machine Perfusion on Preservation Quality of Marginal Donor Livers
,”
Cryobiology
,
60
(
3
), pp.
337
343
.10.1016/j.cryobiol.2010.03.005
24.
Vairetti
,
M.
,
Ferrigno
,
A.
,
Rizzo
,
V.
,
Boncompagni
,
E.
,
Carraro
,
A.
,
Gringeri
,
E.
,
Milanesi
,
G.
,
Barni
,
S.
,
Freitas
,
I.
, and
Cillo
,
U.
,
2008
, “
Correlation Between the Liver Temperature Employed During Machine Perfusion and Reperfusion Damage: Role of Ca2+
,”
Liver Transpl. Surg.
,
14
(
4
), pp.
494
503
.10.1002/lt.21421
25.
Vairetti
,
M.
,
Ferrigno
,
A.
,
Carlucci
,
F.
,
Tabucchi
,
A.
,
Rizzo
,
V.
,
Boncompagni
,
E.
,
Neri
,
D.
,
Gringeri
,
E.
,
Freitas
,
I.
, and
Cillo
,
U.
,
2009
, “
Subnormothermic Machine Perfusion Protects Steatotic Livers Against Preservation Injury: A Potential for Donor Pool Increase?
Liver Transpl. Surg.
,
15
(
1
), pp.
20
29
.10.1002/lt.21581
26.
Lüer
,
B.
,
Koetting
,
M.
,
Efferz
,
P.
, and
Minor
,
T.
,
2010
, “
Role of Oxygen During Hypothermic Machine Perfusion Preservation of the Liver
,”
Transplant Int.
,
23
(
9
), pp.
944
950
.10.1111/j.1432-2277.2010.01067.x
27.
Nishida
,
S.
,
Nakamura
,
N.
,
Kadono
,
J.
,
Komokata
,
T.
,
Sakata
,
R.
,
Madariaga
,
J. R.
, and
Tzakis
,
A. G.
,
2006
, “
Intrahepatic Biliary Strictures After Liver Transplantation
,”
J. Hepato-Biliary-Pancreatic Surg.
,
13
(
6
), pp.
511
516
.10.1007/s00534-005-1081-1
28.
Obara
,
H.
,
Matsuno
,
N.
,
Enosawa
,
S.
,
Shigeta
,
T.
,
Huai-Che
,
H.
,
Hirano
,
T.
,
Muto
,
M.
,
Kasahara
,
M.
,
Uemoto
,
S.
, and
Mizunuma
,
H.
,
2012
, “
Pretransplant Screening and Evaluation of Liver Graft Viability Using Machine Perfusion Preservation in Porcine Transplantation
,”
Transplant. Proc.
,
44
(
4
), pp.
959
961
.10.1016/j.transproceed.2012.01.104
29.
Matsuno
,
N.
,
Sakurai
,
E.
,
Tamaki
,
I.
,
Furuhashi
,
K.
,
Saito
,
A.
,
Zhang
,
S.
,
Kozaki
,
K.
,
Shimada
,
A.
,
Miyamoto
,
K.
, and
Kozaki
,
M.
,
1994
, “
Effectiveness of Machine Perfusion Preservation as a Viability Determination Method for Kidneys Procured From Non-Heart-Beating Donors
,”
Transplant. Proc.
26
, pp.
2421
2422
.
30.
Matsuno
,
N.
,
Konno
,
O.
,
Mejit
,
A.
,
Jyojima
,
Y.
,
Akashi
,
I.
,
Nakamura
,
Y.
,
Iwamoto
,
H.
,
Hama
,
K.
,
Iwahori
,
T.
,
Ashizawa
,
T.
, and
Nagao
,
T.
,
2006
, “
Application of Machine Perfusion Preservation as a Viability Test for Marginal Kidney Graft
,”
Transplantation
,
82
(
11
), pp.
1425
1428
.10.1097/01.tp.0000243733.77706.99
31.
Nyberg
,
S. L.
,
Baskin-Bey
,
E. S.
,
Kremers
,
W.
,
Prieto
,
M.
,
Henry
,
M. L.
, and
Stegall
,
M. D.
,
2009
, “
Improving the Prediction of Donor Kidney Quality: Deceased Donor Score and Resistive Indices
,”
Transplantation
,
80
, pp.
925
929
.10.1097/01.TP.0000173798.04043.AF
32.
Shigeta
,
T.
,
Matsuno
,
N.
,
Obara
,
H.
,
Mizunuma
,
H.
,
Kanazawa
,
H.
,
Tanaka
,
H.
,
Fukuda
,
A.
,
Sakamoto
,
S.
,
Kasahara
,
M.
,
Uemoto
,
S.
, and
Enosawa
,
S.
,
2012
, “
Functional Recovery of Donation After Cardiac Death Liver Graft by Continuous Machine Perfusion Preservation in Pigs
,”
Transplant. Proc.
,
44
(
4
), pp.
946
947
.10.1016/j.transproceed.2012.01.078
33.
Devlin
,
J.
,
Dunne
,
J. B.
,
Sherwood
,
R. A.
,
Chambers
,
S. M.
,
Tan
,
K. C.
,
Peters
,
T. J.
, and
Williams
,
R.
,
1995
, “
Relationship Between Early Liver Graft Viability and Enzyme Activities in Effluent Preservation Solution
,”
Transplantation
,
60
, pp.
627
631
.10.1097/00007890-199510150-00001
34.
Lange
,
R.
,
Erhard
,
J.
,
Rauen
,
U.
,
de Groot
,
H.
, and
Eigler
,
F. W.
,
1996
, “
Determination of Hepatocellular Enzymes in Effluent of Human Liver Grafts for Preoperative Evaluation of Transplant Quality
,”
Transplantation
,
62
, pp.
1255
1259
.10.1097/00007890-199611150-00013
You do not currently have access to this content.