• Rinaldo Bellomo, Glenn M Eastwood, Leah Peck, Bao Zhong Wang, Shane Houston, and Alison Skene.
• Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. rinaldo.bellomo@austin.org.au.
• Crit Care Resusc. 2014 Sep 1;16(3):197-201.

BackgroundDonation after circulatory death (DCD) livers are at markedly increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to transplant DCD livers and may allow their use for artificial extracorporeal liver support of patients with fulminant liver failure.ObjectiveWe conducted two proof-of-concept experiments using human livers after DCD to assess the feasibility and functional efficacy of NELP over an extended period.MethodsWe applied extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion and physiological perfusion pressures to two livers obtained after DCD.ResultsWe achieved NELP and evidence of liver function (bile production, paracetamol removal and maintenance of normal lactate levels) in both livers; one for 24 hours and the other for 43 hours. Histological examination showed areas of patchy ischaemia but preserved biliary ducts and canaliculi.ConclusionsOur experiments justify further investigations of the feasibility and efficacy of extended DCD liver preservation by ex-vivo perfusion.

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