Clinical assessment of liver metabolism during hypothermic oxygenated machine perfusion using microdialysis.
Artif Organs
; 46(2): 281-295, 2022 Feb.
Article
in En
| MEDLINE
| ID: mdl-34516020
ABSTRACT
BACKGROUND:
While growing evidence supports the use of hypothermic oxygenated machine perfusion (HOPE) in liver transplantation, its effects on liver metabolism are still incompletely understood.METHODS:
To assess liver metabolism during HOPE using microdialysis (MD), we conducted an open-label, observational pilot study on 10 consecutive grafts treated with dual-HOPE (D-HOPE). Microdialysate and perfusate levels of glucose, lactate, pyruvate, glutamate, and flavin mononucleotide (FMN) were measured during back table preparation and D-HOPE and correlated to graft function and patient outcome.RESULTS:
Median (IQR) MD and D-HOPE time was 228 (210, 245) and 116 (103, 143) min. Three grafts developed early allograft dysfunction (EAD), with one requiring retransplantation. During D-HOPE, MD glucose and lactate levels increased (ANOVA = 9.88 [p = 0.01] and 3.71 [p = 0.08]). Their 2nd-hour levels were higher in EAD group and positively correlated with L-GrAFT score. 2nd-hour MD glucose and lactate were also positively correlated with cold ischemia time, macrovesicular steatosis, weight gain during D-HOPE, and perfusate FMN. These correlations were not apparent when perfusate levels were considered. In contrast, MD FMN levels invariably dropped steeply after D-HOPE start, whereas perfusate FMN was higher in dysfunctioning grafts.CONCLUSION:
MD glucose and lactate during D-HOPE are markers of hepatocellular injury and could represent additional elements of the viability assessment.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Organ Preservation
/
Liver Transplantation
/
Liver
Type of study:
Observational_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Artif Organs
Year:
2022
Document type:
Article
Affiliation country:
Italy