van der Plaats A, Maathuis M H J, 'T Hart N A, Bellekom A A, Hofker H S, van der Houwen E B, Verkerke G J, Leuvenink H G D, Verdonck P, Ploeg R J, Rakhorst G
Department of BioMedical Engineering, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
Ann Biomed Eng. 2006 Dec;34(12):1924-34. doi: 10.1007/s10439-006-9207-4. Epub 2006 Oct 26.
To improve preservation of donor livers, we have developed a portable hypothermic machine perfusion (HMP) system as an alternative for static cold storage. A prototype of the system was built and evaluated on functionality. Evaluation criteria included 24 h of adequate pressure controlled perfusion, sufficient oxygenation, a maintained 0-4 degrees C temperature and sterile conditions. Porcine livers were perfused with pump pressures that were set at 4 mmHg (continuous, portal vein) and 30/20 mmHg, at 60 BPM (pulsatile, hepatic artery). Control livers were preserved using the clinical golden standard: static cold storage. In the HMP group, pressure, flow and temperature were continuously monitored for 24 h. At time-points t = 0, 2, 4, 8, 12, and 24 h samples of University of Wisconsin machine preservation solution were taken for measurement of partial oxygen pressure (pO(2)) and lacto-dehydrogenase. Biopsies in every lobe were taken for histology and electron microscopy; samples of ice, preservation solution, liver surface, and bile were taken and cultured to determine sterility. Results showed that temperature was maintained at 0-4 degrees C; perfusion pressure was maintained at 4 mmHg and 30/20 mmHg for portal vein and hepatic artery, respectively. Flow was approximately 350 and 80 ml/min, respectively, but decreased in the portal vein, probably due to edema formation. Arterial pO(2) was kept at 100 kPa. Histology showed complete perfusion of the liver with no major damage to hepatocytes, bile ducts, and non-parenchymal cells compared to control livers. The machine perfusion system complied to the design criteria and will have to demonstrate the superiority of machine perfusion over cold storage in transplant experiments.
为了提高供体肝脏的保存效果，我们开发了一种便携式低温机器灌注（HMP）系统，作为静态冷藏的替代方法。构建了该系统的原型并对其功能进行了评估。评估标准包括24小时的适当压力控制灌注、充足的氧合、维持0-4摄氏度的温度以及无菌条件。用设定为4 mmHg（连续，门静脉）和30/20 mmHg、每分钟60次搏动（搏动性，肝动脉）的泵压对猪肝脏进行灌注。对照肝脏采用临床金标准进行保存：静态冷藏。在HMP组中，连续24小时监测压力、流量和温度。在时间点t = 0、2、4、8、12和24小时采集威斯康星大学机器保存液样本，用于测量部分氧分压（pO(2)）和乳酸脱氢酶。对每个肝叶进行活检以进行组织学和电子显微镜检查；采集冰、保存液、肝表面和胆汁的样本并进行培养以确定无菌状态。结果显示温度维持在0-4摄氏度；门静脉和肝动脉的灌注压力分别维持在4 mmHg和30/20 mmHg。流量分别约为350和80 ml/min，但门静脉中的流量有所下降，可能是由于水肿形成。动脉pO(2)保持在100 kPa。组织学显示肝脏完全灌注，与对照肝脏相比，肝细胞、胆管和非实质细胞没有受到重大损伤。该机器灌注系统符合设计标准，并且必须在移植实验中证明机器灌注优于冷藏。
