Evaluation of Liver Maximum Capacity Measurements to Monitor Hepatocellular Function During Extended Normothermic...

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Organ preservation

Background:

• Lactate clearance during normothermic machine perfusion (NMP) inadequately assesses comprehensive hepatocyte function.
• Liver Maximum Capacity (LiMAx) is utilized for liver function assessment before oncological resections.
• Evaluating combined lactate clearance and LiMAx for extended NMP is crucial.

Purpose of the Study:

• To assess the combined utility of lactate clearance and LiMAx for monitoring liver function during extended NMP.
• To determine if this combined approach provides a more comprehensive evaluation of graft viability.

Main Methods:

• Seven discarded donor livers underwent extended NMP (87-184 hours) with a blood-based perfusate.
• Hepatocellular function was assessed every 6 hours using LiMAx with C13-methacetin.
• Lactate clearance capacity was tested every 24 hours using sodium lactate.

Main Results:

• Efficient lactate clearance (<4 hours) correlated with stable LiMAx profiles, indicating preserved hepatocyte function.
• Progressive LiMAx reductions were associated with deteriorating function and graft failure.
• LiMAx enabled real-time, longitudinal monitoring of hepatocyte metabolic activity.

Conclusions:

• Combined LiMAx and lactate clearance offer a comprehensive assessment of graft viability during extended NMP.
• Incorporating LiMAx into viability criteria can refine decision-making for liver transplantation, especially for marginal grafts.
• This combined method enhances the evaluation of hepatocellular function beyond traditional lactate clearance.