Machine Perfusion Parameters to Predict Graft Injury or Early Function After Liver Transplantation

Pushing the limits of acceptance criteria for donor organs requires tools to support the surgeon with appropriate estimation of graft quality. In this study, we evaluated a variety of biomarkers during machine perfusion as potential candidates to predict the fate of the graft after transplantation. Morphological injury to the graft was studied by maximal release of transaminases during the first 3 days after transplantation or early functional recovery as maximum liver function capacity during mechanical ventilation on postoperative day 1.

Twenty extended criteria donor livers from deceased donors were subjected to machine perfusion with MPS solution. Temperature was increased from 10 to 20 °C during the first 60 minutes. Liver function data were obtained after 90 minutes of perfusion.

Significant correlations with peak transaminase levels after transplant were found for perfusate levels of glucose, aspartate aminotransferase, pH, and lactate, with best correlations being evident for the product of aspartate aminotransferase and lactate (r² = 0.86; P < .001). Most interestingly, early liver function (maximal liver function capacity) posttransplant did not significantly correlate with these parameters. The best prognostic factor was aspartate aminotransferase level on the machine, which showed correlation factor of r² = 0.11 (P = .10). Readout of hepatic functional recovery did not correlate with readout of morphological reperfusion injury (peak transaminase levels) (coefficient factor of r² = 0.15). However, function might not easily be prognosticated by predominantly nonfunctional injury parameters. Further development and refine-ment of functional investigations of the organ during machine perfusion are thus recommended.