Title
Oxygenated UW Solution Decreases ATP Decay and Improves Survival After Transplantation of DCD Liver Grafts
UMMS Affiliation
Transplant Division, Department of Surgery; School of Medicine; Senior Scholars Program
Publication Date
2019-02-01
Document Type
Article
Disciplines
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Digestive System | Hepatology | Pathological Conditions, Signs and Symptoms | Surgery
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.
DOI of Published Version
10.1097/TP.0000000000002530
Source
Transplantation. 2019 Feb;103(2):363-370. doi: 10.1097/TP.0000000000002530. Link to article on publisher's site
Journal/Book/Conference Title
Transplantation
Related Resources
PubMed ID
30422952
Repository Citation
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; and Markmann, James F., "Oxygenated UW Solution Decreases ATP Decay and Improves Survival After Transplantation of DCD Liver Grafts" (2019). Surgery Publications and Presentations. 159.
https://escholarship.umassmed.edu/surgery_pp/159
Comments
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.