Observations and findings during the development of a subnormothermic/normothermic long‐term ex vivo liver perfusion machine
Background Ex situliver machine perfusion at subnormothermic/normothermic temperature isincreasingly applied in the field of transplantation to store and evaluateorgans on the machine prior transplantation. Currently, various perfusionconcepts are in clinical and preclinical applications. Over the l...
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| Published in: | Artificial organs Vol. 47; no. 2; pp. 317 - 329 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Wiley Subscription Services, Inc
01-02-2023
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Background
Ex situliver machine perfusion at subnormothermic/normothermic temperature isincreasingly applied in the field of transplantation to store and evaluateorgans on the machine prior transplantation. Currently, various perfusionconcepts are in clinical and preclinical applications. Over the last 6 years ina multidisciplinary team, a novel blood based perfusion technology wasdeveloped to keep a liver alive and metabolically active outside of the bodyfor at least one week.
Methods
Within thismanuscript, we present and compare three scenarios (Group 1, 2 and 3) we werefacing during our research and development (R&D) process, mainly linked tothe measurement of free hemoglobin and lactate in the blood based perfusate. Apartfrom their proven value in liver viability assessment (ex situ), these twoparameters are also helpful in R&D of a long‐term liver perfusion machine and moreover supportive in the biomedical engineering process.
Results
Group 1 (“good” liver on the perfusion machine) represents the best liver clearance capacity for lactate and free hemoglobin wehave observed. In contrast to Group 2 (“poor” liver on the perfusion machine), that has shown the worst clearance capacity for free hemoglobin. Astonishingly,also for Group 2, lactate is cleared till the first day of perfusion andafterwards, rising lactate values are detected due to the poor quality of theliver. These two perfusate parametersclearly highlight the impact of the organ quality/viability on the perfusion process. Whereas Group 3 is a perfusion utilizing a blood loop only (without a liver).
Conclusion
Knowing the feasible ranges (upper‐ and lower bound) and the courseover time of free hemoglobin and lactate is helpful to evaluate the quality ofthe organ perfusion itself and the maturity of the developed perfusion device. Freehemoglobin in the perfusate is linked to the rate of hemolysis that indicates how optimizing (gentle blood handling, minimizing hemolysis) the perfusion machine actually is. Generally, a reduced lactate clearancecapacity can be an indication for technical problems linked to the blood supplyof the liver and therefore helps to monitor the perfusion experiments.Moreover, the possibility is given to compare, evaluate and optimize developed liverperfusion systems based on the given ranges for these two parameters. Otherresearch groups can compare/quantify their perfusate (blood) parameters withthe ones in this manuscript. The presented data, findings and recommendations willfinally support other researchers in developing their own perfusion machine ormodifying commercially availableperfusion devices according to their needs.
Normothermic long‐term ex vivo liver perfusion machine. |
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| Bibliography: | Moreover, I would like to take the chance to say thank you to the whole Liver4Life Team for the good times at ETH Zurich and Wyss Zurich. Special thanks go to Philipp, Dima, Max, Dustin, Matteo, Marcel, and Mark for the exciting and challenging years in the Liver4Life project. Last but not least “a big mille grazie” to my entire family and friends. Martin J. Schuler, Dustin Becker, Matteo Mueller contributed equally. Mark W. Tibbitt, Dilmurodjon Eshmuminov, Max Hefti are co‐senior authors. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0160-564X 1525-1594 |
| DOI: | 10.1111/aor.14403 |