36 hours of ex-vivo warm cellular perfusion of swine liver using the organ care system (OCS™) liver with excellent functional, metabolic and histological outcomes.
Magliocca J, Markmann J, Abouljoud MS, Ghobrial M, Demetris A. 36 hours of ex-vivo warm cellular perfusion of swine liver using the organ care system (OCS™) liver with excellent functional, metabolic and histological outcomes.. 2017; 17:304-305.
Cold storage preservation results in ischemia/reperfusion injury to the donor liver, it lacks any resuscitative or assessment capabilities. The OCS™ Liver maintains livers in a metabolically active and functioning state using warm, oxygenated, blood perfusion of both the hepatic artery and portal vein circulations. Methods: We randomized 6 swine livers to 12 hours of cold storage using Viaspan (Control) vs. 12 hours of OCS Liver perfusion (OCS), followed by 1 hour of cold flush and 24 hours of simulated transplantation using OCS Liver perfusion primed with fresh whole blood from a different swine. We compared the metabolic, functional and histological outcomes between both groups. Results: The mean cold ischemic time (CIT) for Control was 809±1.5min, and 106±3.8 min for OCS. During the 24hr simulated transplant phase the average peak AST level for Control was 1197±597, and 94±28 for OCS. Bile production was maintained at an average rate of 20ml/hour in both groups. Pathological assessment at the end of 24hr simulated transplant showed moderate to mild hepatocyte necrosis in Control compared to minimal to none in OCS (Fig.1A). CD31 stain to assess LSEC damage demonstrated intact sinusoidal endothelial cells in OCS compared to Control (Fig.1B). Extra-hepatic bile duct assessment in Control demonstrated deeper and more extensive arterial thrombosis/necrosis and bile duct necrosis than OCS (Fig.1C) (Figur presented). Conclusion: Livers maintained for 36 hours ex-vivo perfusion on OCS had excellent post-transplant hepatocellular, hepatobiliary, metabolic and synthetic functions compared to cold storage in a 24 hours of simulated transplantation swine model.