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Porcine Normothermic Isolated Liver Perfusion
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Porcine Liver Normothermic Machine Perfusion: Methodological Framework and Potential Pitfalls.
Nicholas Gilbo1,2, Tine Wylin1, Veerle Heedfeld1
1Department of Microbiology, Immunology, and Transplantation, Lab of Abdominal Transplantation, Transplantation Research Group, KU Leuven, Leuven, Belgium.
Transplantation Direct
|December 16, 2021
Summary
Optimizing normothermic machine perfusion (NMP) in porcine liver research requires meticulous attention to equipment and operational details. Methodological refinements, particularly in cannulation, are crucial for stable 24-hour liver preservation.
Area of Science:
- Transplantation research
- Organ preservation techniques
- Surgical research
Background:
- Porcine liver models are vital for transplant research but are operationally challenging.
- Existing NMP protocols lack detailed documentation of implementation and potential pitfalls.
Purpose of the Study:
- To provide a detailed methodological framework for implementing normothermic machine perfusion (NMP) in a porcine liver research model.
- To identify and overcome operational challenges for stable 24-hour liver preservation using NMP.
Main Methods:
- Conducted 13 NMP experiments on porcine livers over three phases, employing a trial-and-error approach.
- Systematically modified NMP settings, focusing on oxygenator performance, perfusate composition, and cannulation techniques.
- Monitored liver function (lactate, pH, bile production), injury markers (AST), hemodynamics, and histology throughout 24-hour perfusion.
Main Results:
- Initial experiments (Phase 1) failed due to oxygenator leakage; subsequent trials (Phase 2) faced portal vein resistance and liver outflow impairment.
- An improved inferior vena cava cannulation technique (Phase 3) resolved outflow issues, leading to reduced AST levels, improved lactate clearance, and preserved bile production.
- Phase 3 achieved stable 24-hour NMP with normal liver histology in 5 experiments.
Conclusions:
- Successful porcine liver NMP requires rigorous auditing of all circuit components and operational procedures.
- Detailed reporting of methodological aspects and troubleshooting is essential for reproducibility in NMP research.
- Refined cannulation techniques are critical for preventing liver outflow impairment during NMP.
