Study design.

Abstract

Donor human livers had standard procurement, they were cold flushed and stored. Once rejected for transplantation, they were offered for research and consecutively allocated to the two experimental groups. Image A shows the protocol for the HOPE+NMP group, livers had hypothermic oxygenated perfusion (HOPE) using Belzer MPS® UW Machine Perfusion Solution for 2 hours. HOPE was performed at 10 °C via the portal vein only, as represented on image C. After 2 hours, the perfusate was changed to an acellular haemoglobin-based oxygen carrier (HBOC) Hemopure® (HBOC-201, Hemoglobin® Oxygen Therapeutics LLC, Cambridge, USA)-based perfusate for the rewarming and normothermic machine perfusion (NMP). The livers from the cold-to-warm group (Image B) were fully cannulated at the start of the perfusion, including portal vein, hepatic artery and common bile duct (Image D). They received the HBOC-based perfusate from time 0. For this group, the livers had 2 hours of dual hypothermic oxygenated perfusion (D-HOPE) at 10 °C followed by 1 hour of slow rewarming to 20 °C (controlled oxygenated rewarming [COR]) and then NMP. Menghini and wedge biopsies were collected at time 0, 2 and 6 hours (**) and immediately fixed in formalin or snap-frozen in liquid nitrogen. Blood gas analysis was carried out and perfusate was sampled at 30 min time intervals throughout. In addition, bile production was measured at time 4 and 6 hours (#) and analysed at 6 hours.</p