Proof of concept: liver splitting during normothermic machine perfusion

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Organ preservation

Background:

• A critical shortage of donor livers for transplantation persists despite the use of extended criteria donors.
• No prior data existed on the feasibility of splitting donor livers during normothermic machine perfusion (NMP-L).

Observation:

• A donor liver after circulatory death was subjected to NMP-L using a red cell-based fluid.
• A 'classical' liver split (left lateral + right trisegmentectomy) was performed during NMP-L using an integrated bipolar/ultrasonic device.
• Doppler ultrasound confirmed blood flow in both separated liver lobes post-procedure.

Findings:

• Physiological flow rates were maintained throughout the NMP-L procedure and splitting process.
• Lactate levels significantly decreased during NMP-L, indicating improved metabolic function.
• Lactate levels remained comparable in hepatic arteries, portal veins, and the IVC before and after splitting.
• Doppler ultrasound confirmed the presence of arterial and venous waveforms in both the left and right liver lobes after splitting.

Implications:

• 'Classical' liver splitting during NMP-L is a feasible technique that maintains the viability of both separated liver grafts.
• This procedure has the potential to mitigate cold ischemic injury, a significant factor in graft survival.
• Enables pre-implantation monitoring of both grafts, potentially improving transplant success rates.
• Facilitates the logistical aspects of transplanting two grafts from a single donor, increasing organ utilization.