Successful temporary machine perfusion of marginal liver grafts early after retrieval or shortly before implantation

OBJECTIVESThe benefit of machine perfusion during storage of liver grafts retrieved after cardiac death should be investigated as applied either at the beginning or near the end of the preservation period. METHODSRat livers were explanted 20 min after cardiac arrest of the donor and cold-stored (CS) for 18 h. Other grafts were additionally subjected to 2 h of normothermic machine perfusion (MP) either 3 h after retrieval (early MP) or 3 h before reperfusion (late MP), thus extending total ischemic time to 20 h. The 3 h period should represent a short transport period between a resident regional pumping center and the explant or implant hospital, respectively. Viability of all livers was assessed thereafter by warm reperfusion in vitro. RESULTSIn comparison to the controls, both regimens significantly improved hepatic recovery upon post-preservation reperfusion as evaluated by enzyme release, bile production, and energetic recovery. Molecular upregulation of pro-inflammatory signals was also significantly mitigated. No functional differences between early and late machine perfusion could be disclosed. CONCLUSIONOur data suggest that it might not be necessary to hurry with the attempt to connect the graft to a machine early after retrieval.