Haemoadsorption cartridge connected to the machine perfusion for donation after circulatory death porcine liver marginal grafts

doi:10.5500/wjt.v15.i2.99287

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World Journal of Transplantation

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Transplant. Jun 18, 2025; 15(2): 99287
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.99287

Haemoadsorption cartridge connected to the machine perfusion for donation after circulatory death porcine liver marginal grafts

Irene Scalera, Rossana Franzin, Alessandra Stasi, Antonino Castellaneta, Enrico Fischetti, Giulia Morelli, Margherita Raele, Emilio Panetta, Andjela Kurevija, William Pulga, Mauro Atti, Loreto Gesualdo

Irene Scalera, Enrico Fischetti, Giulia Morelli, Margherita Raele, Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, Bari 70124, Puglia, Italy

Rossana Franzin, Alessandra Stasi, Loreto Gesualdo, Division of Nephrology, Department of Dialysis and Transplant, University Hospital Policlinic of Bari, Bari 70124, Puglia, Italy

Antonino Castellaneta, Gastroenterology and Digestive Endoscopy Unit, University Hospital Policlinic of Bari, Bari 70124, Puglia, Italy

Emilio Panetta, Andjela Kurevija, William Pulga, Mauro Atti, Department of Aferetica, Aferetica Srl, Bologna 40138, Emilia-Romagna, Italy

Author contributions: Scalera I designed the research study and wrote the manuscript; Fischetti E, Morelli G, and Raele M did the surgical part of the research; Stasi A and Frazin R did the research, analyzed the specimens and the data and wrote the manuscript; Castellaneta A and Gesualdo L reviewed the manuscript; Panetta E, Kureveija A, Pulga W and Atti M collaborated for the logistics; all authors read and approved the final version of the manuscript to be published.

Institutional review board statement: As the study used organs after the slaughter, it didn't require any particular board approbation.

Institutional animal care and use committee statement: All necessary standard measures were taken to preserve the animal welfare, as required by European legislation (EC 1099/2009).

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: Technical aspect for retrieving the grafts after the slaughter are available from the corresponding author at irenescalera@gmail.com.

Corresponding author: Irene Scalera, MD, PhD, Doctor, Surgeon, Hepatobiliary and Liver Transplant Unit, University Hospital Policlinic of Bari, Piazza G Cesare 11, Bari 70124, Puglia, Italy. irenescalera@gmail.com

Received: July 18, 2024
Revised: November 7, 2024
Accepted: January 11, 2025
Published online: June 18, 2025
Processing time: 217 Days and 13.3 Hours

Abstract

BACKGROUND

Marginal donation after circulatory death (DCD) liver grafts are carefully used to combat the constant shortage of donors. Clinically, the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines (CK). The machine perfusion (MP) is a promising device to rescue these grafts.

AIM

To analyze the role of MP connected to a sorbent cartridge (PerSorb^®) and used for very damaged DCD pig livers.

METHODS

Seven grafts were procured from pigs from a slaughterhouse. Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time: (1) 3 grafts were perfused in hypothermic MP with PerSorb (Sorb); (2) 2 other grafts in hypothermic MP (HMP) without the cartridge (NoSorb); and (3) The other 2 livers stored in the ice box (NoTreat). The CK were measured at HMP start (T0) and at the end (Tend). Biopsies were taken at T0 and Tend.

RESULTS

All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment (8.83 at T0 vs 6.4 at Tend of Sorb; 15 at T0 vs 5.45 at Tend for NoSorb, P value > 0.05). At Tend, both Sorb and NoSorb groups had better hemodynamic parameters, comparable between the two groups. Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1, tumor necrosis factor-alpha and interleukin-1β for NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment. Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.

CONCLUSION

These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.

Keywords: Liver donor; Machine perfusion; Sorbent cartridge; Donation after circulatory death; Cytokines; Ischemia-reperfusion-injury

Core Tip: Marginal donation after circulatory death liver grafts are carefully used to fight the constant shortage of donors. Clinically, the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines (CK). The machine perfusion (MP) is a promising device to rescue these grafts. Recently, a new ex-situ MP device incorporating a filter cartridge to the machine has been considered. It was tested on pigs, and it appears to reduce the CK during the treatment of standard liver grafts. The purpose of the study was the analysis of the role of the CK cartridge connected to the MP and used to preserve extremely marginal pig grafts during processing in the MP. The results were analyzed biochemically and histologically.