Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation

UMMS Affiliation

Department of Surgery, Division of Organ Transplantation

Publication Date


Document Type



Adenosine Triphosphate; Adult; Aged; Biliary Tract; Cryopreservation; Feasibility Studies; Female; Humans; Liver; Liver Transplantation; Male; Middle Aged; Organ Preservation


Analytical, Diagnostic and Therapeutic Techniques and Equipment | Surgery | Surgical Procedures, Operative


To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pretransplantation. To determine the feasibility in human livers, we assessed the effect of 3 h of oxygenated subnormothermic machine perfusion (21°C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11-1.94] to 6.74 [4.15-8.16] mL O2 /min kg liver), lactate levels (4.04 [3.70-5.99] to 2.29 [1.20-3.43] mmol/L) and adenosine triphosphate content (45.0 [70.6-87.5] pmol/mg preperfusion to 167.5 [151.5-237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production, was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters postischemia.


Donation after circulatory death, liver transplantation, organ preservation, subnormothermic machine perfusion

DOI of Published Version



Am J Transplant. 2014 Jun;14(6):1400-9. doi: 10.1111/ajt.12727. Epub 2014 Apr 23. Link to article on publisher's site

Journal/Book/Conference Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Related Resources

Link to article in PubMed

PubMed ID