Brüggenwirth, I.M.A. (Isabel) (2016) The Influence of Combined Pulsatile Arterial and Portal Perfusion During Liver Machine Perfusion. thesis, Medicine.
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Abstract
A short period of machine perfusion of donor livers after traditional static cold preservation and before transplantation may reduce preservation injury in donation after circulatory death (DCD) liver grafts. In several studies single portal vein perfusion has been the preferred technique. However, the pulsatile arterial blood flow to the biliary tree may play an important role in bile formation and preservation of the peribiliary vascular plexus (PVP). The aim of this study was to determine the most effective perfusion route during machine preservation of DCD livers. Rat livers (n=18) were preserved by 6 h of cold storage (0-4oC), followed by 1 h sub-normothermic (21oC) machine perfusion and 2 h ex vivo warm (37oC) reperfusion (as a model for transplantation). Machine preservation was either through single portal vein perfusion (SP; n=6), dual pulsatile (DPP; n=6) or dual continuous perfusion (DCP; n=6) of the portal vein and hepatic artery. Our results demonstrate that arterial resistance after reperfusion was lowest in DPP livers. There were no significant differences in histological injury of liver parenchyma, but we did observe histological evidence of better preservation of the large bile duct biliary epithelium in DPP livers. After warm reperfusion, DPP livers showed the highest bile production (0.32 ± 0.03 DPP vs. 0.24 ± 0.12 SP and 0.25 ± 0.19 DCP) and were able to maintain the pH of the perfusion fluid closest to its physiological range (7.234 ± 0.16 DPP vs. 7.229 ± 0.17 SP and 7.18 ± 0.20 DCP). Lactate values in the perfusion fluid were lowest in the SP group and highest in CDP livers (3.33 ± 1,35 vs. 3.66 ± 1.52 respectively, p=0.03). This study shows that end-ischemic sub-normothermic machine perfusion using either single or dual pulsatile perfusion of DCD livers provides similar outcomes after ex situ reperfusion. Overall, the work presented in this thesis may contribute to the development of the most effective machine perfusion preservation method.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Porte, Robert J. MD and Professor of Surgery and Department of Surgery, Section of Hepato-Pancreato-Biliary S and Transplantation and University Medical Center Groningen and Groningen, The Netherlands |
| Supervisor name: | Martins, Paulo N. MD and Department of Surgery, Division of Organ Transplantation and UMass Memorial Medical Center and Worcester, MA and United States |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/125 |
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