Ex Situ Machine Perfusion of Human Donor Livers via the Surgically Reopened Umbilical Vein: A Proof of Concept

Background: Machine perfusion of donor livers is typically performed via the portal vein main stem. Instead, cannulation of a reopened umbilical vein could allow machine perfusion during organ procurement and subsequent implantation in the recipient without interruption of the portal venous circulation. We aimed to assess the feasibility of portal venous machine perfusion via the umbilical vein. Methods: During back table inspection of five human livers declined for transplantation, the umbilical vein was surgically reopened, dilated and cannulated. Hypothermic and normothermic oxygenated machine perfusion (NMP) were performed using the umbilical vein for portal inflow. Three livers were perfused with hypothermic machine perfusion, one full liver graft underwent NMP for four hours, and one left lateral split procedure was performed under continuous NMP with portal perfusion via the umbilical vein. Results: In all livers access to the portal venous system via the umbilical vein was successfully achieved, with good portal flows and macroscopically homogeneous perfusion. The full liver graft that underwent NMP via the umbilical vein for four hours showed good lactate clearance, normalized pH and achieved good bile production with pH >7.55. During the split procedure under continuous NMP via the umbilical vein, the left lateral segment and extended right lobe remained equally perfused, as demonstrated by Doppler-ultrasound. Conclusion: Machine perfusion with portal perfusion via the umbilical vein is feasible. Portal venous flows were similar to those obtained after cannulation of the portal vein main stem. This technique enables continuous oxygenated perfusion of liver grafts during procurement, splitting and implantation. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Conflicts of interest: The authors have no conflicts of interest to declare. Financial disclosure: No funding was obtained for this study. Corresponding Author: Vincent de Meijer, MD, PhD, Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Tel.: +31503612896 / Fax: +31 50 361 4873 Email: v.e.de.meijer@umcg.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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