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Wash-out of the non-heart-beating donor liver: a matter of flush solution and temperature?


T.M. van Gulik, MD, PhD, Surgical Laboratory, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Abstract: Background and Aims: Ischemically damaged donor livers are prone to graft non-function. This can in part be explained by a suboptimal wash-out during procurement. An enriched machine perfusion (MP) preservation solution for livers, named Polysol, was developed. The aim of this study was to investigate the type of flush solution, temperature and anticoagulant content on the wash-out of the non-heart-beating donor (NHBD) rat liver.

Methods: Rat livers were flushed after 30 min warm ischemia. After excision, livers were reperfused at 37°C, with analysis of damage and function, concerning (1) solutions (University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK) and Polysol); (2) temperature (4°C, 18°C and 37°C); (3) addition of heparin and (4) wash-out followed by 24 h MP.

Results: (1) Reperfusion results were inferior in the UW group; (2) less damage and improved function were seen after wash-out using Polysol at 37°C; (3) No effects were seen of the addition of heparin to Polysol; (4) MP after wash-out using HTK resulted in more liver damage and decreased liver function as compared with wash-out using Polysol.

Conclusions: Polysol is applicable as a flush solution for the NHBD liver, resulting in equal to better wash-out as compared with UW and HTK. The best temperature for this NHBD wash-out is 37°C.