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Research Papers

Rewarming Machine Perfusion System for Liver Transplantation

[+] Author and Article Information
Hiromichi Obara

Department of Mechanical Engineering,
Tokyo Metropolitan University,
1-1 Minamiosawa, Hachioji,
Tokyo, Japan
e-mail: obara@tmu.ac.jp

Naoto Matsuno

Department of Transplantation,
Division for Advanced Medical Sciences,
Clinical Research Center,
National Center for Child Health and Development,
2-10-1 Okura Setagaya-ku,
Tokyo, Japan

Takanobu Shigeta

Department of Transplantation,
Clinical Research Center,
National Center for Child Health
and Development,
2-10-1 Okura Setagaya-ku,
Tokyo, Japan
Division of Hepato-Biliary-Pancreatic
and Transplant Surgery,
Kyoto University,
Yoshida-Konoe-cho,Sakyo-ku,
Kyoto, Japan

Shin Enosawa

Division for Advanced Medical Sciences,
Clinical Research Center,
National Center for Child Health and Development,
2-10-1 Okura Setagaya-ku,
Tokyo, Japan

Toshihiko Hirano

Department of Clinical Pharmacology,
Tokyo University of Pharmacy and Life Science,
1432-1 Horinouchi, Hachioji,
Tokyo, Japan

Hiroshi Mizunuma

Department of Mechanical Engineering,
Tokyo Metropolitan University,
1-1 Minamiosawa, Hachioji,
Tokyo, Japan

1Corresponding author.

Manuscript received December 24, 2012; final manuscript received June 17, 2013; published online October 25, 2013. Assoc. Editor: Keefe B. Manning.

J. Med. Devices 7(4), 041011 (Oct 25, 2013) (7 pages) Paper No: MED-12-1161; doi: 10.1115/1.4025189 History: Received December 24, 2012; Revised June 17, 2013

The liver is one of the most essential organs, and transplantation is an established treatment for patients with end-stage disease who have lost their liver function. However, organ shortage is a critical problem in transplantation; thus, the development of an innovative preservation system to adopt critical grafts obtained from extended criteria donors or donation after cardiac death donors as viable organs for transplantation is necessary. We recently developed a novel rewarming machine perfusion preservation system for liver transplantation, and herein discuss this system, which allows the perfusion temperature to be controlled during the transition from hypothermic to subnormothermic conditions. This system has two functions: (1) the preservation and recovery of organ function and (2) screening the organ for viability. To achieve these functions, this system has three features: (1) temperature control of the preservation perfusate and liver graft, (2) dual-controlled perfusion of the portal vein and hepatic artery, and (3) real-time monitoring of the perfusion conditions, including the flow rate, perfusion pressure and temperature. This system was useful for liver preservation and for evaluating the graft viability and recovery of functions during machine perfusion before transplantation. This novel rewarming machine preservation system was tested in an experimental model using porcine liver grafts. We report that this system has certain advantages in liver preservation, and believe that this system will positively contribute to the expansion of the organ donor pool.

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Figures

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Fig. 1

A schematic diagram of the machine perfusion system

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Fig. 2

The transplantation procedure from procurement to implantation

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Fig. 3

The temperature control charts of the HMP (a) and RMP (b) conditions (Tx: transplantation, RP: reperfusion)

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Fig. 4

The average temperature transition of the preservation perfusate and liver graft during a period of 90–120 min of the RMP experiment (n = 3)

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Fig. 5

The PV and the HA pressure during machine perfusion

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Fig. 6

The average HA pressure transitions during HMP and RMP

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Fig. 7

The cumulative release of (a) AST, (b) ALT and (c) LDH during machine perfusion (empty symbols indicate HMP and solid symbols indicate RMP)

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Fig. 8

The enzyme release rate of RMP compared with that of HMP (striped bars indicate HMP and solid bars indicate RMP)

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