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Original Article | Open Access

Ischemia‐Free Liver Implantation Versus Normothermic Machine Perfusion: Evaluation of Feasibility and Security

Zhitao Chen1,2,3, Yuqi Dong1,2,3, Maogen Chen1,2,3, Qiang Zhao1,2,3, Tielong Wang1,2,3, Yiwen Guo1,2,3, Honghui Chen1,2,3, Tao Zhang1,2,3, Yongqi Yang1,2,3, Yifang Gao1,2,3, Zhiyong Guo1,2,3, Weiqiang Ju1,2,3( ), Xiaoshun He1,2,3 ( )
Organ Transplant Center, First Affiliated Hospital of Sun Yat‐sen University, Guangzhou, Guangdong, China
Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, Guangdong, China
Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, Guangdong, China

Zhitao Chen, Yuqi Dong, and Maogen Chen contributed equally to this study.

Show Author Information

Graphical Abstract

Compared with standard NMP, IFLI has been improved in the process of implantation to maintain a constant blood supply during implantation, thereby avoiding re‐IRI. IFLI demonstrated superior postoperative liver function recovery and a reduced incidence of complications, while also exhibiting enhanced safety and feasibility.

Abstract

Background

Further optimization and improvement of normothermic machine perfusion (NMP) is necessary, as it can still lead to ischemia injury in transplanted livers. We propose a novel method, termed ischemia‐free liver implantation (IFLI), which maintains a constant blood supply throughout both the preservation and implantation processes. This study aimed to evaluate the feasibility and safety of IFLI compared to NMP.

Methods

Thirty‐four recipients of IFLI and 17 recipients of NMP were enrolled. The recovery of liver function, complication rates, and survival outcomes were compared between the groups.

Results

The mean cold ischemia time (CIT), anhepatic time, and surgical duration were 5.94 ± 0.41 h, 50.59 ± 2.10 min, and 439.32 ± 13.25 min for the IFLI group, and 6.29 ± 0.52 h, 54.65 ± 4.32 min, and 428.06 ± 22.04 min for the NMP group (p = 0.333, 0.086, and 0.135, respectively). The IFLI group had a significantly lower incidence of post‐reperfusion syndrome compared to the NMP group (8% vs. 58.8%, p < 0.001), and the incidence rate of PNF was higher in the NMP group (p = 0.041).

Conclusion

IFLI, by maintaining constant blood supply during implantation, avoids re‐ischemia‐reperfusion injury (re‐IRI) and demonstrates improved postoperative liver function recovery, fewer complications, and greater safety compared to standard NMP.

Keywords

early allograft dysfunctionischemia‐free implantationischemia‒reperfusion injurynormothermic machine perfusionprimary non‐function

References

1

J. C. Messinger, D. W. Hanto, M. P. Curry, and K. Ladin, “Liver Transplantation in Alcohol‐Associated Liver Disease: Ensuring Equity Through New Processes,” Liver Transplantation 29, no. 5 (2023): 539–547, https://doi.org/10.1097/LVT.0000000000000088.
Crossref Google Scholar
2

A. Schlegel, M. van Reeven, K. Croome, et al., “A Multicentre Outcome Analysis to Define Global Benchmarks for Donation After Circulatory Death Liver Transplantation,” Journal of Hepatology 76, no. 2 (2022): 371–382, https://doi.org/10.1016/j.jhep.2021.10.004.
Crossref Google Scholar
3

G. Sapisochin and J. Bruix, “Liver Transplantation for Hepatocellular Carcinoma: Outcomes and Novel Surgical Approaches,” Nature Reviews Gastroenterology & Hepatology 14, no. 4 (2017): 203–217, https://doi.org/10.1038/nrgastro.2016.193.
Crossref Google Scholar
4

J. Eden, R. Sousa Da Silva, M. Cortes‐Cerisuelo, et al., “Utilization of Livers Donated After Circulatory Death for Transplantation—An International Comparison,” Journal of Hepatology 78, no. 5 (2023): 1007–1016, https://doi.org/10.1016/j.jhep.2023.01.025.
Crossref Google Scholar
5

M. Ravaioli, G. Germinario, G. Dajti, et al., “Hypothermic Oxygenated Perfusion in Extended Criteria Donor Liver Transplantation—A Randomized Clinical Trial,” American Journal of Transplantation 22, no. 10 (2022): 2401–2408, https://doi.org/10.1111/ajt.17115.
Crossref Google Scholar
6

P. Dutkowski, J. V. Guarrera, J. de Jonge, P. N. Martins, R. J. Porte, and P. A. Clavien, “Evolving Trends in Machine Perfusion for Liver Transplantation,” Gastroenterology 156, no. 6 (2019): 1542–1547, https://doi.org/10.1053/j.gastro.2018.12.037.
Crossref Google Scholar
7

A. Hann, A. Nutu, G. Clarke, et al., “Normothermic Machine Perfusion‐Improving the Supply of Transplantable Livers for High‐Risk Recipients,” Transplant International 35 (2022): 10460, https://doi.org/10.3389/ti.2022.10460.
Crossref Google Scholar
8

F. di Francesco, D. Pagano, G. Martucci, D. Cintorino, and S. Gruttadauria, “Normothermic Machine Perfusion in Liver Transplantation: Feasibility and Promise of Avoiding Recooling Before Engrafting,” Liver Transplantation 25, no. 7 (2019): 1113–1117, https://doi.org/10.1002/lt.25473.
Crossref Google Scholar
9

X. He, Z. Guo, Q. Zhao, et al., “The First Case of Ischemia‐Free Organ Transplantation in Humans: A Proof of Concept,” American Journal of Transplantation 18, no. 3 (2018): 737–744, https://doi.org/10.1111/ajt.14583.
Crossref Google Scholar
10

Q. Zhao, S. Huang, D. Wang, et al., “Does Ischemia Free Liver Procurement Under Normothermic Perfusion Benefit the Outcome of Liver Transplantation?,” Annals of Transplantation 23 (2018): 258–267.
Crossref Google Scholar
11

W. Ju, Z. Chen, Q. Zhao, et al., “Non‐Re‐Cooling Implantation of Marginal Liver Graft After Machine Perfusion: Report of a Case,” Annals of Translational Medicine 8, no. 21 (2020): 1465, https://doi.org/10.21037/atm-20-2774.
Crossref Google Scholar
12

Z. Chen, T. Wang, C. Chen, et al., “Transplantation of Extended Criteria Donor Livers Following Continuous Normothermic Machine Perfusion Without Recooling,” Transplantation 106, no. 6 (2022): 1193–1200, https://doi.org/10.1097/tp.0000000000003945.
Crossref Google Scholar
13

F. Rauchfuß, H. M. Tautenhahn, F. Dondorf, A. Ali‐Deeb, and U. Settmacher, “Critical Evaluation of Discarded Donor Livers in the Eurotransplant Region: Potential Implications for Machine Perfusion,” Annals of Transplantation 28 (2023): e938132, https://doi.org/10.12659/aot.938132.
Crossref Google Scholar
14

I. Vodkin and A. Kuo, “Extended Criteria Donors in Liver Transplantation,” Clinical Liver Disease 21, no. 2 (2017): 289–301, https://doi.org/10.1016/j.cld.2016.12.004.
Crossref Google Scholar
15

B. Kok, V. Dong, and C. J. Karvellas, “Graft Dysfunction and Management in Liver Transplantation,” Critical Care Clinics 35, no. 1 (2019): 117–133, https://doi.org/10.1016/j.ccc.2018.08.002.
Crossref Google Scholar
16

Á. L. Szilágyi, P. Mátrai, P. Hegyi, et al., “Compared Efficacy of Preservation Solutions on the Outcome of Liver Transplantation: Meta‐Analysis,” World Journal of Gastroenterology 24, no. 16 (2018): 1812–1824, https://doi.org/10.3748/wjg.v24.i16.1812.
Crossref Google Scholar
17

P. Ramos, P. Williams, J. Salinas, et al., “Abdominal Organ Preservation Solutions in the Age of Machine Perfusion,” Transplantation 107, no. 2 (2023): 326–340, https://doi.org/10.1097/tp.0000000000004269.
Crossref Google Scholar
18

H. Mergental, M. T. P. R. Perera, R. W. Laing, et al., “Transplantation of Declined Liver Allografts Following Normothermic Ex‐Situ Evaluation,” American Journal of Transplantation 16, no. 11 (2016): 3235–3245, https://doi.org/10.1111/ajt.13875.
Crossref Google Scholar
19

M. W. Manning, P. A. Kumar, K. Maheshwari, and H. Arora, “Post‐Reperfusion Syndrome in Liver Transplantation—An Overview,” Journal of Cardiothoracic and Vascular Anesthesia 34, no. 2 (2020): 501–511, https://doi.org/10.1053/j.jvca.2019.02.050.
Crossref Google Scholar
20

A. D. Shubin, C. A. Feizpour, C. S. Hwang, et al., “Normothermic Machine Perfusion for Older Transplant Recipients,” Artificial Organs 47, no. 7 (2023): 1184–1191, https://doi.org/10.1111/aor.14519.
Crossref Google Scholar
21

Y. Zhang, Y. Nie, L. Liu, and X. Zhu, “Assessing the Prognostic Scores for the Prediction of the Mortality of Patients With Acute‐on‐Chronic Liver Failure: A Retrospective Study,” PeerJ 8 (2020): e9857, https://doi.org/10.7717/peerj.9857.
Crossref Google Scholar
22

M. Chen, Z. Chen, X. Lin, et al., “Application of Ischemia‐Free Liver Transplantation Improves Prognosis of Patients With Steatotic Donor Livers—A Retrospective Study,” Transplant International 34, no. 7 (2021): 1261–1270, https://doi.org/10.1111/tri.13828.
Crossref Google Scholar
23

J. Li, H. Lu, J. Zhang, Y. Li, and Q. Zhao, “Comprehensive Approach to Assessment of Liver Viability During Normothermic Machine Perfusion,” Journal of Clinical and Translational Hepatology 11, no. 2 (2023): 466–479, https://doi.org/10.14218/jcth.2022.00130.
Crossref Google Scholar
24

Z. Chen, X. Hong, S. Huang, et al., “Continuous Normothermic Machine Perfusion for Renovation of Extended Criteria Donor Livers Without Recooling in Liver Transplantation: A Pilot Experience,” Frontiers in Surgery 8, no. 131 (2021): 638090, https://doi.org/10.3389/fsurg.2021.638090.
Crossref Google Scholar
25

M. B. Khosravi, H. Sattari, S. Ghaffaripour, et al., “Post‐Reperfusion Syndrome and Outcome Variables After Orthotopic Liver Transplantation,” International Journal of Organ Transplantation Medicine 1, no. 3 (2010): 115–120.
Google Scholar
26

A. Siniscalchi, L. Gamberini, C. Laici, et al., “Post Reperfusion Syndrome During Liver Transplantation: From Pathophysiology to Therapy and Preventive Strategies,” World Journal of Gastroenterology 22, no. 4 (2016): 1551–1569, https://doi.org/10.3748/wjg.v22.i4.1551.
Crossref Google Scholar
27

A. Siniscalchi, L. Gamberini, T. Bardi, et al., “Post‐Reperfusion Syndrome During Orthotopic Liver Transplantation, Which Definition Best Predicts Postoperative Graft Failure and Recipient Mortality?,” Journal of Critical Care 41 (2017): 156–160, https://doi.org/10.1016/j.jcrc.2017.05.020.
Crossref Google Scholar
28

Ł. Masior and M. Grąt, “Primary Nonfunction and Early Allograft Dysfunction After Liver Transplantation,” Digestive Diseases 40, no. 6 (2022): 766–776, https://doi.org/10.1159/000522052.
Crossref Google Scholar
29

T. Ito, B. V. Naini, D. Markovic, et al., “Ischemia‐Reperfusion Injury and Its Relationship With Early Allograft Dysfunction in Liver Transplant Patients,” American Journal of Transplantation 21, no. 2 (2021): 614–625, https://doi.org/10.1111/ajt.16219.
Crossref Google Scholar
30

D. Nasralla, “Incremental Improvements in Machine Perfusion,” Transplantation 106, no. 6 (2022): 1105–1106, https://doi.org/10.1097/tp.0000000000003946.
Crossref Google Scholar
Organ Medicine
Volume 1 Issue 1,
September 2024
Pages 21-29
DOI: 10.1002/orm2.9
Cite this article:
Chen Z, Dong Y, Chen M, et al. Ischemia‐Free Liver Implantation Versus Normothermic Machine Perfusion: Evaluation of Feasibility and Security. Organ Medicine, 2024, 1(1): 21-29. https://doi.org/10.1002/orm2.9

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Received: 24 August 2024
Accepted: 05 September 2024
Published: 24 October 2024
© 2024 The Author(s).

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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