This study explores the feasibility and efficacy of the PerLife® system for ex-situ liver perfusion and purification, focusing on extended criteria donors (ECD). ECD organs, although increasing the donor pool, are at higher risk of post-transplant complications. The study presents preliminary results of using dual hypothermic oxygenated perfusion (DHOPE) and normothermic machine perfusion (NMP) protocols with the PerLife® system and PerSorb® sorbent.
Two liver grafts were retrieved from ECDs. The first case involved a 55-year-old male donor who died from head trauma with hemodynamic instability. The second case involved a 70-year-old female donor who died from anoxia and had 45% macro steatosis. Initially, a 90-minute DHOPE treatment was conducted to familiarize with the system. Subsequently, the second liver underwent NMP with the integration of the PerSorb® sorbent to remove inflammatory mediators from the perfusate. Oxygenation was provided at 2L/min and adjusted based on blood-gas evaluations. Perfusion parameters, including pressure, flow, resistance, and temperature, were continuously monitored, with perfusate samples collected every 30 minutes.
During the DHOPE treatment, arterial flow increased from 60 to 80 mL/min, and venous flow from 190 to 250 mL/min. In the NMP treatment, arterial flow increased from 70 to 170 mL/min, and portal flow from 250 to 860 mL/min. A significant decrease in perfusate lactate levels by 89.9% was observed after 220 minutes of NMP, indicating improved metabolic function. Perfusate IL-6 levels peaked at 602 pg/mL and decreased to 371 pg/mL by the end of perfusion.
Both liver grafts were successfully transplanted. The first graft was transplanted into a 66-year-old male with HCV and HCC (MELD-Na 13), and the second into a 43-year-old male with NASH and HCC (MELD-Na 18). The peak transaminase levels post-transplant were 930 IU/L and 787 IU/L for the first and second case, respectively. Both recipients had uneventful postoperative courses and showed good outcomes at 5 and 4 months follow-up.
This preliminary experience demonstrates that ex-situ liver perfusion using the PerLife® system, including DHOPE and NMP protocols, is safe and feasible. The addition of the PerSorb® sorbent during NMP provided optimal organ perfusion, reducing lactate levels and inflammatory mediators. Further research is needed to fully understand the potential benefits of inflammatory mediator adsorption in ex-situ liver perfusion.
1 Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
2 Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.