Biliary Bicarbonate, pH, and Glucose Are Suitable Biomarkers of Biliary Viability During Ex Situ Normothermic Machine Perfusion of Human Donor Livers
| Autor: | Ton Lisman, Robert J. Porte, Annette S. H. Gouw, Masato Fujiyoshi, Marieke T. de Boer, Yvonne de Vries, Ruben H J de Kleine, Henkjan J. Verkade, Laura C. Burlage, Alix P M Matton, Rianne van Rijn, Vincent E de Meijer |
|---|---|
| Přispěvatelé: | Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Lifestyle Medicine (LM), Vascular Ageing Programme (VAP) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Bicarbonate BILE-DUCT Urology Cold storage Carbohydrate metabolism chemistry.chemical_compound COLD-STORAGE Biopsy medicine INJURY CIRCULATORY-DEATH PRESERVATION Machine perfusion medicine.diagnostic_test Bile duct business.industry Donor selection TRANSPLANTATION ISCHEMIC CHOLANGIOPATHY Original Clinical Science—Liver Transplantation medicine.anatomical_structure REOXYGENATION chemistry CARDIAC DEATH ComputingMethodologies_DOCUMENTANDTEXTPROCESSING DONATION business |
| Zdroj: | Transplantation, 103(7), 1405-1413. LIPPINCOTT WILLIAMS & WILKINS Transplantation |
| ISSN: | 1534-6080 0041-1337 |
| Popis: | Supplemental Digital Content is available in the text. Background. Ex situ normothermic machine perfusion (NMP) can be used to assess viability of suboptimal donor livers before implantation. Our aim was to assess the diagnostic accuracy of bile biochemistry for the assessment of bile duct injury (BDI). Methods. In a preclinical study, 23 human donor livers underwent 6 hours of end-ischemic NMP to determine biomarkers of BDI. Livers were divided into groups with low or high BDI, based on a clinically relevant histological grading system. During NMP, bile was analyzed biochemically and potential biomarkers were correlated with the degree of BDI. Receiver operating characteristics curves were generated to determine optimal cutoff values. For clinical validation, identified biomarkers were subsequently included as viability criteria in a clinical trial (n = 6) to identify transplantable liver grafts with low BDI. Results. Biliary bicarbonate and pH were significantly higher and biliary glucose was significantly lower in livers with low BDI, compared with high BDI. The following cutoff values were associated with low BDI: biliary bicarbonate greater than 18 mmol/L (P = 0.002), biliary pH greater than 7.48 (P = 0.019), biliary glucose less than 16 mmol/L (P = 0.013), and bile/perfusate glucose ratio less than 0.67 (P = 0.013). In the clinical trial, 4 of 6 livers met these criteria and were transplanted, and none developed clinical evidence of posttransplant cholangiopathy. Conclusions. Biliary bicarbonate, pH, and glucose during ex situ NMP of liver grafts are accurate biomarkers of BDI and can be easily determined point of care, making them suitable for the pretransplant assessment of bile duct viability. This may improve graft selection and decrease the risk of posttransplant cholangiopathy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|