Noninvasive 13C-methacetin Liver Function Breath Test as a Tool for Functional Assessment During Normothermic Machine Perfusion of Porcine Livers

Transplantation Direct, vol. 11, pp. e1876

Abstract

Background. Several viability tests, including lactate clearance and bile production, are used to evaluate livers during normothermic machine perfusion (NMP). However, specific cutoff values and therapeutic consequences vary significantly. The noninvasive 13 C-methacetin liver function breath test (LiMAx) was developed to measure the actual liver function capacity. This might also provide useful insights into graft function during NMP. Methods. Therefore, we used an established porcine model of prolonged static cold storage (pSCS) and subsequent NMP for additional functional monitoring with the LiMAx test. Livers obtained from 9 pigs underwent NMP for 6 h directly after procurement (control group) or after 20 h of SCS (pSCS). After 6 h of NMP, the LiMAx test was performed using a liver weight-adjusted dose of 13 C-methacetin. Results. After pSCS, transaminase and cholestasis parameters were found to be elevated in the perfusate and reduced lactate clearance was measured. Bile analyses further revealed reduced bile production and elevated glucose concentrations. In line with these results, the LiMAx test also showed significantly reduced values compared with the control group, with a mean value of 57.0 µg/kg/h compared with 182.0 µg/kg/h in the control group ( P = 0.032). Conclusions. Therefore, we suggest the LiMAx test as a novel diagnostic tool for evaluating donor organs during NMP.

Authors 10

1. Sebastian Cammann Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

2. Oliver Beetz Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

3. Clara A. Weigle Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

4. Philipp Tessmer Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

5. Bengt Arne Wiemann

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

6. Daphne E. DeTemple Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

7. Lavinia Neubert

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of Pathology, Hannover Medical School, Hannover, Germany

8. Wolf Ramackers Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

9. Florian W. R. Vondran Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

10. Felix Oldhafer corresponding Aachen Department of General, Visceral Pediatric and Transplant Surgery

    Medizinische Hochschule Hannover · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

    Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany