Porcine Isolated Liver Perfusion for the Study of Ischemia Reperfusion Injury: a Systematic Review

BACKGROUNDUnderstanding ischemia reperfusion injury (IRI) is essential to further improve outcomes after liver transplantation (LT). Porcine isolated liver perfusion (ILP) is increasingly used to reproduce LT-associated IRI in a strictly controlled environment. However, whether ILP is a reliable substitute of LT was never validated. METHODSWe systematically reviewed the current experimental set-ups for ILP and parameters of interest reflecting IRI. RESULTSILP was never compared to transplantation in animals. Considerable variability exists between set-ups and comparative data are unavailable. Experience so far suggests that centrifugal pump(s) with continuous flow are preferred to reduce the risk of embolism. Hepatic outflow can be established by cannulation of the inferior vena cava or freely drained in an open bath. Whole blood at ~38°C, hematocrit ≥ 20%, and the presence of leukocytes to trigger inflammation is considered the optimal perfusate. A number of parameters related to the 4 liver compartments (hepatocyte, cholangiocyte, endothelium, immune cells) are available; however, their significance and relation to clinical outcomes is not well described. CONCLUSIONSPorcine ILP provides a reproducible model to study early IRI events. As all models it has its limitations. A standardization of the set-up would allow comparison of data and progress in the field.