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Updated: Aug 30, 2025
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Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
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Predicting Early Allograft Function After Normothermic Machine Perfusion
Christopher J E Watson1,2,3,4, Rohit Gaurav4, Corrina Fear4
1Department of Surgery, University of Cambridge, Level E9, Addenbrooke's Hospital, Cambridge, United Kingdom.
Transplantation
|August 31, 2022
Summary
Assessing donor liver viability during normothermic ex situ perfusion is crucial. Key perfusate markers like alanine transaminase, lactate, and pH predict early allograft function, guiding transplant decisions.
Area of Science:
- Transplantation Medicine
- Organ Preservation
- Hepatology
Background:
- Normothermic ex situ liver perfusion (NEP) is vital for donor liver assessment.
- Limited evidence exists for NEP viability and early allograft function prediction criteria.
Purpose of the Study:
- To identify perfusate variables from NEP that best predict the Model for Early Allograft Function (MEAF) score.
- To refine criteria for donor liver viability assessment using NEP.
Main Methods:
- Analysis of perfusate variables from 203 livers undergoing NEP.
- Multivariable analysis to correlate perfusate markers with MEAF score.
- Comparison of outcomes for donation after circulatory death (DCD) and donation after brain death (DBD) livers.
Main Results:
- 2-hour alanine transaminase, 2-hour lactate, 11-29 mmol supplementary bicarbonate (first 4h), and peak bile pH predicted MEAF score.
- 154 of 203 perfused livers were transplanted.
- Non-anastomotic biliary strictures occurred in 11% of transplants.
Conclusions:
- Confirms the importance of 2-hour alanine transaminase, lactate, and bicarbonate for liver assessment during NEP.
- Highlights the need for caution when using lactate as a sole viability indicator.
- Suggests cholangiocyte function markers may aid in predicting early allograft function.
