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09:29
Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
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Liver function maximum capacity test during normothermic regional perfusion predicts graft function after
Ivo J Schurink1, Femke H C de Goeij1, Fenna J van der Heijden1
1Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Zuid Holland The Netherlands.
The EPMA Journal
|September 6, 2024
Summary
The liver maximum capacity (LiMAx) test objectively assesses donor liver function during abdominal normothermic regional perfusion (aNRP). This innovative approach helps prevent post-transplant complications by enabling personalized donor-recipient matching for liver transplantation.
Area of Science:
- Transplantation immunology
- Organ preservation
- Surgical innovation
Background:
- Extended criteria donor organs, including donation after circulatory death (DCD), are increasingly used to combat transplant waitlist mortality.
- Current risk assessment relies on generalized nomograms, lacking precision for individual donor organ evaluation.
- Abdominal normothermic regional perfusion (aNRP) allows for in-situ organ assessment, but a definitive functional gold standard is needed.
Purpose of the Study:
- To evaluate the feasibility of using the liver maximum capacity (LiMAx) test to objectively assess liver function during aNRP.
- To determine if LiMAx measurements can predict donor liver suitability and prevent post-transplant complications.
- To establish an individualized approach for matching donor livers to recipients.
Main Methods:
- Abdominal normothermic regional perfusion (aNRP) was performed on 18 donation after circulatory death (DCD) liver grafts.
- The liver maximum capacity (LiMAx) test was integrated into the aNRP circuit for real-time liver function assessment.
- Continuous variables were analyzed, presenting data as median with interquartile range.
Main Results:
- The LiMAx test was successfully performed in 94% of aNRP procedures.
- Higher LiMAx scores correlated with better lactate clearance and were observed in livers with stress hyperglycemia during aNRP.
- LiMAx scores accurately distinguished between livers selected for transplantation and those discarded, showing a strong correlation with AST and ALT levels.
Conclusions:
- The LiMAx test is feasible for assessing individual donor liver function during aNRP.
- LiMAx provides an objective measure to predict liver function and potential complications, enabling personalized donor-recipient matching.
- This test can enhance donor liver selection, reduce post-transplant complications, and personalize liver transplantation outcomes.
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