Clinical assessment of liver metabolism during hypothermic oxygenated machine perfusion using microdialysis
| Autor: | Nicola Leone, Damiano Patrono, Anna Teresa Mazzeo, Giorgia Catalano, Alessandro Gambella, Vito Fanelli, Elena Mazza, Federica Rigo, Vincenzo Elia, Giorgia Rizza, Dorotea Roggio, Renato Romagnoli, Caterina Lonati, Daniele Dondossola |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Microdialysis microdialysis medicine.medical_treatment Biomedical Engineering Medicine (miscellaneous) Flavin mononucleotide Bioengineering Pilot Projects Liver transplantation Cold Ischemia Time Biomaterials chemistry.chemical_compound Internal medicine extracellular fluid flavin mononucleotide liver metabolism liver viability assessment machine perfusion Extracellular fluid medicine Humans Lactic Acid Prospective Studies Aged Machine perfusion business.industry Cold Ischemia Graft Survival Glutamate receptor General Medicine Organ Preservation Middle Aged Liver Transplantation Perfusion Endocrinology Glucose chemistry Liver Female medicine.symptom business Weight gain |
| Popis: | BACKGROUND While growing evidence supports the use of hypothermic oxygenated machine perfusion (HOPE) in liver transplantation, its effects on liver metabolism are still incompletely understood. METHODS To assess liver metabolism during HOPE using microdialysis (MD), we conducted an open-label, observational pilot study on 10 consecutive grafts treated with dual-HOPE (D-HOPE). Microdialysate and perfusate levels of glucose, lactate, pyruvate, glutamate, and flavin mononucleotide (FMN) were measured during back table preparation and D-HOPE and correlated to graft function and patient outcome. RESULTS Median (IQR) MD and D-HOPE time was 228 (210, 245) and 116 (103, 143) min. Three grafts developed early allograft dysfunction (EAD), with one requiring retransplantation. During D-HOPE, MD glucose and lactate levels increased (ANOVA = 9.88 [p = 0.01] and 3.71 [p = 0.08]). Their 2nd-hour levels were higher in EAD group and positively correlated with L-GrAFT score. 2nd-hour MD glucose and lactate were also positively correlated with cold ischemia time, macrovesicular steatosis, weight gain during D-HOPE, and perfusate FMN. These correlations were not apparent when perfusate levels were considered. In contrast, MD FMN levels invariably dropped steeply after D-HOPE start, whereas perfusate FMN was higher in dysfunctioning grafts. CONCLUSION MD glucose and lactate during D-HOPE are markers of hepatocellular injury and could represent additional elements of the viability assessment. |
| Databáze: | OpenAIRE |
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