Mueller M, Hefti M, Eshmuminov D, Schuler MJ, Sousa Da Silva RX, Petrowsky H, De Oliveira ML, Oberkofler CE, Hagedorn C, Mancina L, Weber A, Burg B, Tibbitt MW, Rudolf von Rohr P, Dutkowski P, Becker D, Bautista Borrego L, Clavien PA
Organ shortage remains the single most important factor limiting the success of transplantation. Auto-transplantation in patients with non-resectable liver tumors is rarely feasible due to insufficient tumor-free remnant tissue. This limitation could be solved by the availability of long-term preservation of partial livers enabling functional regeneration and subsequent transplantation. Building on successful ex situ machine perfusion of whole livers, we developed a new system in partial porcine livers to perfuse human right or left hemi-livers. Our experience with whole liver perfusion in a porcine and human model revealed new challenges when applied to perfusion of partial livers, requiring innovative perfusate-filtering, special cannulas to connect vessels and bile ducts and control for physiologic oxygenation in artery and portal vein. Partial porcine livers could be successfully perfused for one week exhibiting physiologic functions with fully preserved integrity upon histology examination. Following this development phase, 21 partial human livers were perfused, eventually reaching the targeted perfusion duration of one week with the final protocol. Those partial livers disclosed a stable perfusion and normal hepatic function including bile production, lactate clearance, as well as maintenance of energy in form of adenosine triphosphate and glycogen levels, with fully preserved liver architecture based on histological analysis for up to one week.
Ann Surg. 2021 Nov 1;274(5):836-842.
Perfusion Machine for partial human livers. A, The Wyss perfusion machine in the certified clean room. B, Simplified schematics of the perfusion machine with all main components. C, Representative picture of a cannulated partial human liver before connection to the machine (metal and polyamide cannulas in blood vessels and 3 polyurethane tubes in bile ducts).