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    Oxygenated UW Solution Decreases ATP Decay and Improves Survival After Transplantation of DCD Liver Grafts

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    Authors
    Martins, Paulo N.A.
    Berendsen, Timothy A.
    Yeh, Heidi
    Bruinsma, Bote G.
    Izamis, Maria-Louisa
    Op den Dries, Sanna
    Gillooly, Andrew R.
    Porte, Robert
    Yarmush, Martin L.
    Uygun, Korkut
    Markmann, James F.
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    UMass Chan Affiliations
    Senior Scholars Program
    School of Medicine
    Transplant Division, Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2019-02-01
    Keywords
    Analytical, Diagnostic and Therapeutic Techniques and Equipment
    Digestive System
    Hepatology
    Pathological Conditions, Signs and Symptoms
    Surgery
    
    Metadata
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    Link to Full Text
    https://doi.org/10.1097/TP.0000000000002530
    Abstract
    BACKGROUND: Donation after circulatory death (DCD) liver grafts are known to be predisposed to primary nonfunction and ischemic cholangiopathy. Many DCD grafts are discarded because of older donor age or long warm ischemia times. Thus, it is critical to improve the quality of DCD liver grafts. Here, we have tested whether an enriched oxygen carrier added to the preservation solution can prolong graft survival and reduce biliary damage. METHODS: We assessed the adenosine triphosphate (ATP) content decay of mouse liver grafts after cold ischemia, warm ischemia, and combined warm+cold ischemia. In addition, we used a rat model of liver transplantation to compare survival of DCD grafts preserved in high-oxygen solution (preoxygenated perfluorocarbon [PFC] + University of Wisconsin [UW] solution) versus lower oxygen solution (preoxygenated UW solution). RESULTS: Adenosine triphosphate levels under UW preservation fall to less than 10% after 30 minutes of warm ischemia. Preoxygenated UW solution with PFC reached a significantly higher PaO2. After 45 minutes of warm ischemia in oxygenated UW + PFC solution, grafts showed 63% higher levels of ATP (P = 0.011). In addition, this was associated with better preservation of morphology when compared to grafts stored in standard UW solution. Animals that received DCD grafts preserved in higher oxygenation solution showed improved survival: 4 out of 6 animals survived long-term whereas all control group animals died within 24 hours. CONCLUSIONS: The additional oxygen provided by PFC during static cold preservation of DCD livers can better sustain ATP levels, and thereby reduce the severity of ischemic tissue damage. PFC-based preservation solution extends the tolerance to warm ischemia, and may reduce the rate of ischemic cholangiopathy.
    Source

    Transplantation. 2019 Feb;103(2):363-370. doi: 10.1097/TP.0000000000002530. Link to article on publisher's site

    DOI
    10.1097/TP.0000000000002530
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49734
    PubMed ID
    30422952
    Notes

    Andrew Gillooly participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1097/TP.0000000000002530
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