Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation

Adam M. Thorne, BSc; Veerle Lantinga, BSc; Silke Bodewes, BSc; Ruben H. J. de Kleine, MD; Maarten W. Nijkamp, MD, PhD; Joost Sprakel, MD; Hermien Hartog, MD, PhD; Wojciech G. Polak, MD, PhD; Robert J. Porte, MD, PhD; Vincent E. de Meijer, MD, PhD

doi:10.1097/TXD.0000000000001116

Transplantation Direct (Mar 2021)

Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation

Adam M. Thorne, BSc,
Veerle Lantinga, BSc,
Silke Bodewes, BSc,
Ruben H. J. de Kleine, MD,
Maarten W. Nijkamp, MD, PhD,
Joost Sprakel, MD,
Hermien Hartog, MD, PhD,
Wojciech G. Polak, MD, PhD,
Robert J. Porte, MD, PhD,
Vincent E. de Meijer, MD, PhD

Affiliations

Adam M. Thorne, BSc: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Veerle Lantinga, BSc: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Silke Bodewes, BSc: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ruben H. J. de Kleine, MD: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Maarten W. Nijkamp, MD, PhD: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Joost Sprakel, MD: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Hermien Hartog, MD, PhD: 2 Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Wojciech G. Polak, MD, PhD: 2 Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Robert J. Porte, MD, PhD: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Vincent E. de Meijer, MD, PhD: 1 Department of Surgery, Section of HPB Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

DOI: https://doi.org/10.1097/TXD.0000000000001116
Journal volume & issue: Vol. 7, no. 3
p. e666

Abstract

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Background. Liver splitting allows the opportunity to share a deceased graft between 2 recipients but remains underutilized. We hypothesized that liver splitting during continuous dual hypothermic oxygenated machine perfusion (DHOPE) is feasible, with shortened total cold ischemia times and improved logistics. Here, we describe a left lateral segment (LLS) and extended right lobe (ERL) liver split procedure during continuous DHOPE preservation with subsequent transplantation at 2 different centers. Methods. After transport using static cold storage, a 51-year-old brain death donor liver underwent end-ischemic DHOPE. During DHOPE, the donor liver was maintained 106 kPa. An ex situ ERL/LLS split was performed with continuing DHOPE throughout the procedure to avoid additional ischemia time. Results. Total cold ischemia times for the LLS and ERL were 205 minutes and 468 minutes, respectively. Both partial grafts were successfully transplanted at 2 different transplant centers. Peak aspartate aminotransferase and alanine aminotransferase were 172 IU/L and 107 IU/L for the LLS graft, and 839 IU/L and 502 IU/L for the ERL graft, respectively. The recipient of the LLS experienced an episode of acute cellular rejection. The ERL transplantation was complicated by severe acute pancreatitis with jejunum perforation requiring percutaneous drainage and acute cellular rejection. No device-related adverse events were observed. Conclusions. Liver splitting during continuous DHOPE preservation is feasible, has the potential to substantially shorten cold ischemia time and may optimize transplant logistics. Therefore liver splitting with DHOPE can potentially improve utilization of split liver transplantation.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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