Controlled Oxygenated Rewarming of Cold Stored Livers Prior to Transplantation: First Clinical Application of a New Concept

Transplantation. 2016 Jan;100(1):147-52. doi: 10.1097/TP.0000000000000915.


Background: Abrupt temperature shift from hypothermia to normothermia incurred on reperfusion of organ grafts has been delineated as a genuine factor contributing to reperfusion injury and graft dysfunction after transplantation.

Methods: In a first clinical series of 6 patients, cold-stored livers, all allocated by the rescue offer mechanism by Eurotransplant, were subjected to machine-assisted slow controlled oxygenated rewarming (COR) for 90 minutes before engrafting. A historical cohort of 106 patients basically similar in graft (all rescue offer organs) and recipient factors was used for comparison.

Results: The clinical benefit of COR was documented by a significant reduction by approximately 50% in peak serum transaminases after transplantation compared to untreated controls (AST 563.5 vs. 1204 U/L, P = 0.023). After 6 months graft survival was 100% in the COR group and 80.9% in the controls (P = 0.24). Respective patient survival was 100% and 84.7% (P = 0.28). Real-time assessment of glucose concentration in the perfusion solution correlated well with postoperative synthetic graft function (r = 0.78; P < 0.02). All treated recipients had normal liver function after a 6-month follow-up and are well and alive.

Conclusions: This first clinical application suggests that controlled graft rewarming after cold storage is a feasible and safe method in clinical praxis and might become an adjunct in organ preservation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cold Ischemia* / adverse effects
  • Cold Ischemia* / mortality
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / surgery*
  • Feasibility Studies
  • Female
  • Graft Survival
  • Hepatectomy*
  • Humans
  • Liver Function Tests
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Oxygen / adverse effects
  • Oxygen / therapeutic use*
  • Perfusion / adverse effects
  • Perfusion / methods*
  • Perfusion / mortality
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Prospective Studies
  • Rewarming / adverse effects
  • Rewarming / methods*
  • Rewarming / mortality
  • Risk Factors
  • Time Factors
  • Treatment Outcome


  • Oxygen