Preimplant Normothermic Liver Perfusion of a Suboptimal Liver Donated After Circulatory Death

Am J Transplant. 2016 Jan;16(1):353-7. doi: 10.1111/ajt.13448. Epub 2015 Sep 22.


Livers retrieved after circulatory death are associated with an increased incidence of primary nonfunction, early allograft dysfunction, and biliary strictures. The authors report a case of preimplant normothermic perfusion of a suboptimal liver from a 57-year-old donor after circulatory death who had been hospitalized for 9 days; predonation alanine transaminase level was 63 IU/L, and the period from withdrawal of life-supporting treatment to circulatory arrest was 150 minutes. After 5 hours of static cold storage, the liver was subject to normothermic machine perfusion with a plasma-free red cell-based perfusate. Perfusate lactate level fell from 7.2 to 0.3 mmol/L within 74 minutes of ex situ perfusion, at which point perfusate alanine transaminase level was 1152 IU/L and urea concentration was 9.4 mmol/L. After 132 minutes, normothermic perfusion was stopped and implantation begun. After transplantation, the patient made an uneventful recovery and was discharged on day 8; liver biochemistry was normal by day 19 and has remained normal thereafter. Donor common bile duct excised at implantation showed preservation of peribiliary glands, and cholangiography 6 months posttransplantation showed no evidence of cholangiopathy. Preimplant ex situ normothermic perfusion of the liver appears to be a promising way to evaluate a marginal liver before transplantation and may modify the response to ischemia.

Keywords: Preimplant ex situ normothermic liver perfusion; donation after circulatory death; liver transplantation.

Publication types

  • Case Reports

MeSH terms

  • Heart Arrest*
  • Humans
  • Liver / blood supply*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Organ Preservation
  • Perfusion*
  • Prognosis
  • Tissue Donors
  • Tissue and Organ Procurement / methods*