Assessment of Graft Metabolism and Function During Normothermic Ex Vivo Liver Perfusion - Objective Assessment Prior to Transplantation
an increased risk for postoperative graft failure. Many of these marginal grafts would have provided good function after transplantation but our current inability to assess grafts prior to transplantation results in the wasting of this important resource.
To overcome this obstacle we have developed a novel Normothermic Ex Vivo Liver Perfusion (NEVLP) circuit as an alternative preservation technique for Liver Transplantation (LT). During NEVLP the liver is metabolically active with bile production, oxygen consumption, ATP synthesis, and lactate metabolism. Livers can be preserved on the NEVLP for several hours, which for the first time, offers the unique opportunity to study graft function prior to the transplant procedure. The aim of our study is to identify biomarkers during NEVLP that predict outcome after liver transplantation in a porcine model. We will investigate in heart beating and DCD pig liver transplant experiments NEVLP characteristics that will determine outcome of the graft after reperfusion. In addition, we will evaluate the metabolism of portal field zone 1 and 3 during NEVLP by administrating rocuronium and midazolam.
In Toronto, we have already initiated a human clinical trial using NEVLP as the preservation technique prior to liver transplantation. So far, 11 human liver transplants have been performed successfully in the Toronto Multi Organ Transplant Program. Our research team is fully involved in the experimental porcine model of ex vivo liver perfusion and in the NEVLP human clinical trial. We will apply the results of the animal experiments to the clinical trial and validate our findings in humans.
Identifying markers of graft function during NEVLP that predict outcome after transplantation will allow us to safely extend the donor pool and reduce the mortality on the waiting list.