Bile formation in long-term (1 week), ex situ perfused livers: Analysis and commentary

In the article by Eshmuminov et al 1 Eshmuminov D. Schuler M.J. Becker D. et al. Bile formation in long-term ex situ perfused livers. Surgery. 2021; 169: 894-902 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar entitled “Bile formation in long term (1 week) ex situ perfused livers,” the authors explore a novel protocol for stimulation of bile flow during prolonged liver allograft machine perfusion. Using their previously developed machine perfusion system, which mimics physiological conditions through the inclusion of continuous artificial pancreatic monitoring and hormonal supplementation, dialysate-based blood filtration, and oxygenation, 2 Eshmuminov D. Becker D. Bautista Borrego L. et al. An integrated perfusion machine preserves injured human livers for 1 week. Nat Biotechnol. 2020; 38: 189-198 Crossref PubMed Scopus (114) Google Scholar the authors show feasibility in a porcine transplantation model, followed with application of long-term monitoring to discarded human liver grafts. Building on the experience of other groups in machine perfusion and stimulated bile flow during preservation, 2 Eshmuminov D. Becker D. Bautista Borrego L. et al. An integrated perfusion machine preserves injured human livers for 1 week. Nat Biotechnol. 2020; 38: 189-198 Crossref PubMed Scopus (114) Google Scholar , 3 Nasralla D. Coussios C.C. Mergental H. et al. and the Consortium for Organ Preservation in Europe. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018; 557: 50-56 Crossref PubMed Scopus (476) Google Scholar , 4 Imber C.J. St Peter S.D. de Cenarruzabeitia I.L. et al. Optimisation of bile production during normothermic preservation of porcine livers. Am J Transplant. 2002; 2: 593-599 Crossref PubMed Scopus (52) Google Scholar this group explores the effect of long-term liver perfusion on graft function and the mechanics of bile flow. Prolonged ex situ liver perfusion in clinical application could allow for resuscitation of livers that are marginal or of questionable viability for immediate transplantation. Understanding of the biomechanics and ideal conditions for prolonged liver preservation are critical for these future efforts. This study seeks to improve long-term liver preservation conditions by optimizing real-time organ functional monitoring prior to delayed implantation. Bile formation in long-term ex situ perfused liversSurgeryVol. 169Issue 4PreviewLong-term ex situ liver perfusion may rescue injured grafts. Little is known about bile flow during long-term perfusion. We report the development of a bile stimulation protocol and motivate bile flow as a viability marker during long-term ex situ liver perfusion. Full-Text PDF