Transplantation of high risk donor livers

There currently is a shortage of suitable donor livers in the Netherlands. In 2016, waiting list mortality was 17%. In that same year 32% of all donor livers were declined for transplantation, due to an estimated high risk of complications, such as primary non-function, early allograft dysfunction en biliary complications. In this dissertation was investigated if initially declined donor lives could potentially be used for transplantation. A combined protocol of hypo- and normothermic oxygenated machine perfusion was used to resuscitate and evaluate these initially declined donor livers (DHOPE-COR-NMP trial). During normothermic (body temperature) machine perfusion the liver had to meet certain criteria to be accepted for transplantation. These criteria reflected hepatobiliary function- and injury. The perfusion solution was based on artificial haemoglobin. The use of this HBOC-201- based perfusion solution was found to be safe. Furthermore, 20% extra livers were transplanted in the UMCG in 2018 with the DHOPE-COR-NMP protocol.  In another study in this dissertation pH, bicarbonate and glucose in bile were shown to be accurate predictors of histological bile duct injury. Histological bile duct injury has been associated with biliary complications post transplantation. In the final chapter of the dissertation was investigated whether dual hypothermic oxygenated machine perfusion via the portal vein and hepatic artery (DHOPE) is superior to hypothermic oxygenated machine perfusion via the portal vein alone (HOPE). Porcine livers that underwent DHOPE had less hepatobiliary injury than porcine livers that underwent HOPE.

Dissertation: http://hdl.handle.net/11370/ed3808cb-d9ff-4dad-9841-fce45cf0c4a1