Cold flush after dynamic liver preservation protects against ischemic changes upon reperfusion - an experimental...

Area of Science:

• Transplantation immunology
• Organ preservation
• Surgical innovation

Background:

• Ex vivo machine perfusion (EVMP) with controlled rewarming enhances liver graft viability.
• The protective role of cold flushing after EVMP and before implantation is debated.
• Limited experimental evidence exists for cold flushing's benefit after sub-normothermic rewarming.

Purpose of the Study:

• To investigate the protective effect of a cold flush after EVMP and before simulated implantation.
• To evaluate organ function and injury markers following cold flushing in a porcine liver model.

Main Methods:

• Porcine livers underwent 18 hours of cold storage followed by 90 minutes of EVMP with rewarming to 20°C.
• One group received a cold flush (4°C Belzer UW solution) post-perfusion; the control group did not.
• Both groups experienced 45 minutes of warm ischemia before assessment in a reperfusion model.

Main Results:

• Cold-flushed livers showed significantly increased bile production and reduced alanine aminotransferase and glutamate dehydrogenase release.
• Lower levels of free radical-mediated lipid peroxidation were observed in the cold-flushed group.
• No significant differences were found in histological injury or hepatic energy metabolism (ATP levels).

Conclusions:

• Post-EVMP cold flushing appears beneficial for liver preservation, enhancing recovery markers.
• The protective effect is evident even after sub-normothermic rewarming (20°C).
• Cold flushing is a potentially valuable addition to liver preservation protocols, without apparent adverse effects.