Related Experiment Video
Updated: Jun 9, 2025
Normothermic Ex Vivo Liver Machine Perfusion in Mouse
Published on: September 25, 2023
A reproducible extended ex-vivo normothermic machine liver perfusion protocol utilising improved nutrition and
George Clarke1,2,3, Jingwen Mao4,5, Angus Hann6,4,5
1Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2TH, UK. George.Clarke@uhb.nhs.uk.
Background:
Normothermic machine perfusion of donor livers has become standard practice in the field of transplantation, allowing the assessment of organs and safe extension of preservation times. Alongside its clinical uses, there has been expanding interest in extended normothermic machine perfusion (eNMP) of livers as a potential vehicle for medical research. Reproducible extended normothermic machine perfusion has remained elusive due to its increased complexity and monitoring requirements. We set out to develop a reproducible protocol for the extended normothermic machine perfusion of whole human livers.
Methods:
Human livers declined for transplantation were perfused using a blood-based perfusate at 36 °C using the Liver Assist device (XVIVO, Sweden), with continuous veno-venous haemofiltration in-parallel. We developed the protocol in a stepwise fashion.
Results:
Perfusion techniques utilised included: targeted physiological vascular flows, phosphate replacement (to prevent hypophosphataemia), N-acetylcysteine (to prevent methaemoglobin accumulation), and the utilisation of sodium lactate as both a nutritional source and real-time measure of hepatocyte function. All five human livers perfused with the developed protocol showed preserved function with a median perfusion time of 168 h (range 120-184 h), with preserved viability throughout.
Conclusions:
Livers can be reproducibly perfused in excess of 120 (range 121-184) hours with evidence of preserved hepatocyte and cholangiocyte function.
