Normothermic machine perfusion reduces ischemic reperfusion injury of DCD liver grafts in pig liver transplantation

Objective To investigate the effect of normothermic machine perfusion (NMP) in alleviating the ischemia reperfusion injury of DCD grafts. Methods Twenty-four Bama miniature pigs were randomly divided into two groups. The donor livers were harvested after 40-min cardiac arrest and preserved for 6 h by NMP preservation in the group A, or with cold UW solution in the group B, respectively. Then, liver transplantation was performed in both groups. Choleresis and the perfusate biochemical markers in the group A were detected during NMP. The recipient survival rate, the serum biochemical markers as well as the histopathological changes of the donor livers were compared between these two groups. Results The levels of ALT, AST and LDH in the perfusate were slightly elevated at the beginning of NMP and maintained at a stable level thereafter. The average choleresis rate was 10.3±3.61 mL/h. The histological structures of the donor livers were normal after 6-h NMP preservation. The survival rate of the recipient pigs was 100% and 0 in the group A and group B, respectively. After reperfusion, the levels of serum ALT, AST, LDH and lactic acid in the group A were significantly lower than those in the group B (P<0.05). The pathological examination demonstrated that the hepatocyte injury in group A was slighter than that in group B after 6-h preservation and reperfusion. Conclusion NMP storage could significantly alleviate the ischemia reperfusion injury of pig DCD livers and improve the prognosis of liver transplantation. Key words: Pig; Liver transplantation; Normothermic; Machine perfusion; Reperfusion injury