Hypothermic machine perfusion reduces reperfusion injury of the bile ducts after transplantation of donation after circulatory death livers

R. van Rijn, O.B. van Leeuwen, A.P.M. Matton, L.C. Burlage, R.H.J. de Kleine, M.T. de Boer, A.S.H. Gouw, R.J. Porte

Chair(s): prof. dr. F.J. Bemelman & prof. dr. R. Goldschmeding

Thursday 9 march 2017

9:24 - 9:36h at Hendrik Marsmanzaal

Categories: Parallel - Basaal

Parallel session: Parallelsessie IX – Basaal 2 - Biomarkers gerelateerd aan rejectie na orgaantransplantatie

Although donation after circulatory death (DCD) livers are increasingly used for transplantation, these organs are associated with an increased risk of biliary complications due to ischemia reperfusion injury (IRI). hypothermic machine perfusion (HMP) has been advocated as a method to reduce IRI after liver transplantation. The aim of this study was to determine whether oxygenated HMP reduces IRI of the bile ducts after transplantation of DCD livers. In a recently performed phase 1 trial ten DCD livers were preserved with end-ischemic oxygenated HMP prior to transplantation. Biopsies were obtained from the common bile duct at the end of static cold storage (before HMP; baseline) and after graft reperfusion in the recipient. The histological severity of biliary injury was graded according to an established semi-quantative grading system in a blinded fashion. Twenty DCD liver transplantations in our center that were not preserved with HMP served as controls. Baseline characteristics were comparable between the two groups. As expected, the degree of bile duct injury at baseline was similar between the study groups. After reperfusion, in the control group, the degree of biliary stroma necrosis (p=0.004) and injury of the periluminal peribiliary glands (p=0.017) increased compared to baseline. In contrast, in HMP preserved livers the degree of biliary injury after reperfusion did not increase compared to baseline. In accordance, there was less injury of the periluminal (p=0.043) and deep peribiliary glands (p=0.043) after graft reperfusion in the HMP group, compared to the control group. In conclusion, this study suggests that oxygenated HMP reduces IRI of the bile ducts after transplantation of DCD livers. Whether HMP leads to a decrease in the incidence of biliary complications after DCD liver transplantation, is currently investigated in a multicenter randomized controlled trial (Clinicaltrial.gov NTC02584283).