TY - JOUR
T1 - Hypothermic machine preservation in liver transplantation revisited
T2 - Concepts and criteria in the new millennium
AU - van der Plaats, Arjan
AU - 't Hart, Nils A.
AU - Verkerke, Gijsbertus J.
AU - Leuvenink, Henri G.D.
AU - Ploeg, Rutger J.
AU - Rakhorst, Gerhard
PY - 2004/4/1
Y1 - 2004/4/1
N2 - To overcome the present shortage of liver donors by expansion of the existing donor pool and possibly lengthening of the storage time, hypothermic machine perfusion of the liver as a dynamic preservation method is revisited. The three most important aspects are defined to be the type of preservation solution, the characteristics of perfusion dynamics, and the oxygen supply. Reviewing hypothermic liver machine perfusion experiments, the University of Wisconsin machine preservation solution is the solution most used. It is also found that nothing conclusive can be said about the optimal perfusion characteristics, since either perfusion pressure or perfusion flow is reported. The best estimation is perfusion of the liver in a physiological manner, i.e. pulsatile arterial perfusion and continuous portal venous perfusion. The applied pressures could be chosen to be somewhat lower than physiological pressures to prevent possible endothelial cell damage. Oxygen supply is necessary to achieve optimal preservation of the liver. The minimal amount of partial oxygen pressure required is inversely related to the normalized flow. Incorporating these features in a system based on existing standard surgical and organ sharing procedures and which is able to work stand-alone for 24 h, weighing less than 23 kg, could successfully implement this technique into every day clinical practise.
AB - To overcome the present shortage of liver donors by expansion of the existing donor pool and possibly lengthening of the storage time, hypothermic machine perfusion of the liver as a dynamic preservation method is revisited. The three most important aspects are defined to be the type of preservation solution, the characteristics of perfusion dynamics, and the oxygen supply. Reviewing hypothermic liver machine perfusion experiments, the University of Wisconsin machine preservation solution is the solution most used. It is also found that nothing conclusive can be said about the optimal perfusion characteristics, since either perfusion pressure or perfusion flow is reported. The best estimation is perfusion of the liver in a physiological manner, i.e. pulsatile arterial perfusion and continuous portal venous perfusion. The applied pressures could be chosen to be somewhat lower than physiological pressures to prevent possible endothelial cell damage. Oxygen supply is necessary to achieve optimal preservation of the liver. The minimal amount of partial oxygen pressure required is inversely related to the normalized flow. Incorporating these features in a system based on existing standard surgical and organ sharing procedures and which is able to work stand-alone for 24 h, weighing less than 23 kg, could successfully implement this technique into every day clinical practise.
KW - Hypothermic machine perfusion
KW - Liver
KW - Oxygen demand
KW - Perfusion characteristics
KW - University of Wisconsin solution
UR - http://www.scopus.com/inward/record.url?scp=2642586576&partnerID=8YFLogxK
U2 - 10.1023/B:ABME.0000019181.18194.51
DO - 10.1023/B:ABME.0000019181.18194.51
M3 - Review article
C2 - 15117035
AN - SCOPUS:2642586576
VL - 32
SP - 623
EP - 631
JO - Annals of biomedical engineering
JF - Annals of biomedical engineering
SN - 0090-6964
IS - 4
ER -