Related Experiment Video
Updated: May 3, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Is It Time to Introduce Ex-Situ Normothermic Machine Perfusion in Paediatric Liver Transplantation?
Anita Niu1, Ngee-Soon Lau1, Mark Ly1
1Centre for Organ Assessment Repair and Optimisation, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia; Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia.
Background:
The clinical use of normothermic machine perfusion in liver transplantation currently excludes paediatric recipients due to the challenges of perfusing smaller grafts and risk of portal hyperperfusion injury. This study aimed to evaluate the haemodynamic conditions and histological changes of left lateral segment grafts (LLSG) during long-term normothermic machine perfusion (LT-NMP).
Methods:
Human livers underwent LT-NMP and were split within 24 h of reperfusion into a LLSG and extended right graft (ERG). The LLSG consisted of segments 2 and 3, the coeliac trunk, left portal vein and left hepatic duct, to simulate a realistically-sized graft for clinical use. Vascular haemodynamic parameters, biochemical markers including endothelin-1 and histopathological signs of portal hyperperfusion injury were measured.
Results:
Ten LLSGs were assessed. The median survival time was 5.7 days after splitting. LLSGs had higher portal venous resistance but similar weight-adjusted flow compared to ERGs. In the LLSGs, endothelin-1 levels remained low and there were no significant changes in histological signs of hyperperfusion injury over time.
Conclusions:
This is the first preclinical model to demonstrate that LT-NMP of LLSGs does not cause significant hyperperfusion injury. This opens the opportunity to expand the use of NMP to resuscitate marginal grafts in paediatric liver transplantation.
