An innovative model of en bloc liver-pancreas-kidney preservation via ex vivo hypothermic acellular machine perfusion.

Background: Liver machine perfusion (MP) has emerged as a promising organ preservation modality. Recent studies have shown that the addition of the kidneys to the circuit improves the biochemical environment and could benefit liver preservation. The aim of this study was to explore the technical and anatomical feasibility of en bloc liver-pancreas-kidney MP. We also examined the safety of ex vivo perfusion with a nonoxygen carrier solution and its effects on acid-base and metabolic parameters using this novel multivisceral perfusion platform.

Methods: Five multivisceral allografts, including liver, pancreas, duodenum, and kidney, were perfused for 4 h with acellular perfusate. Hemodynamic and laboratory data were evaluated throughout the experiment.

Results: No system failure was reported. There were minimal changes in the acid-base parameters during the experiment. Lactate and glucose levels were stable throughout hypothermic perfusion. There was a mild increase in liver function parameters in the last hour of hypothermic perfusion. No changes in creatinine levels were observed throughout the study. The urine output increased steadily during the experiment, with an average of 155.6 mL/h.

Conclusion: We described an innovative multivisceral MP technique that could be further used as a platform for physiological studies and targeted therapeutic interventions. Further investigations are necessary to evaluate this ex vivo perfusion technique and provide insights into the feasibility of hypothermic acellular multivisceral MP in clinical scenarios.