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Initial Organ Flush Temperature in Liver Preservation
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- Author / Creator
- Nostedt, Jordan Joseph
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Waitlist mortality resulting from a shortage of transplantable liver grafts has led to increased use of donation after circulatory death (DCD) grafts. However these marginal grafts are associated with higher complication rates. Normothermic ex-situ perfusion of DCD livers has shown encouraging results in both animal and clinical trials as a potential preservation strategy to expand safe use of DCD grafts. Following procurement, initial flush with a cold preservation solution is the standard of care. There is concern that initial cold flush followed by warming may lead to additional liver injury, however the optimal initial flush temperature has not yet been identified. We hypothesized that avoiding hypothermia during initial organ flush will lead to better quality DCD liver grafts. Following simulated DCD with 60 minutes of warm ischemic time, 24 pigs underwent liver procurement and initial organ flush for a period of 5 minutes. The current clinical standard of 4°C histidine-tryptophan-ketoglutarate (HTK) served as the control group. Livers were also flushed with HTK at 25°C and 35°C (n=4 per group). For additional comparison a normokalemic adenosine-lidocaine crystalloid solution (AD) at the same temperatures (n=4 per group) was also used. Livers then underwent 12 hours of normothermic perfusion. Adenosine triphosphate, lactate and hepatocellular injury markers were determined. In the HTK groups hepatocellular injury markers and hemodynamic parameters were lower in the 4°C group while the AD groups demonstrated the opposite pattern. There was no statistical difference in these parameters when all groups were compared. All groups demonstrated similar recovery of ATP levels and lactate clearance after warm ischemic time. These results suggest that altering the temperature of the initial flush solution alone does not provide added benefit over the current clinical standard of cold initial flush with HTK for DCD livers preserved with normothermic perfusion. However, larger powered studies to investigate the effects of alternative solutions such as AD at warmer initial flush temperatures may be warranted.
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- Subjects / Keywords
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- Graduation date
- Fall 2019
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
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