SUPPLEMENTAL DIGITAL CONTENT
CASE DETAILS
The liver was from a 71-year-old brainstem dead donor (DBD), who died following an intracranial haemorrhage. Macroscopically, the donor liver was moderately steatotic with a yellowish appearance (Figure 1) and a decision was made to test viability using the Liver Assist device. Viability was determined using parameters we have previously published. 1 Perfusion criteria were favourable, and the liver was transplanted into a 69-year-old female with alcoholic liver disease. Initial graft function was satisfactory (Supplementary Table 1). Time 0 biopsy of the implant demonstrated mild to moderate macrosteatosis with a moderate degree of reperfusion injury.
A transient rise in liver biochemistry at day 17 posttransplantation prompted ultrasound imaging and, due to suboptimal views, a computed tomography (CT) scan was performed. This identified multiple linear low attenuation areas within an otherwise normal liver and patent vasculature. The low attenuation areas correspond to the cradle lattice of the Liver Assist, clearly seen on volume-rendered 3D and axial CT images (Figure 1). Currently, graft function remains good over 2 years after transplantation.
Table S1: Summary of donor and recipient characteristics ALT: alanine
aminotransferase, BMI: Body Mass Index, CIT: cold ischemia time, DBD: Donation after brainstem death, INR: International Normalized Ratio, NESLiP:
Normothermic ex situ Liver Perfusion.
Donor Details
Age 71
BMI (kg/m2) 32
Donor Liver Weight (kg) 1.8kg
Donor Type DBD
Cause of Death Intracranial
Hemorrhage
Donor Risk Index 2 2.0
UK Donor Liver Index 1.15
Cold ischemia time prior to NESLiP (min) 245
Duration of NESLiP (min) 451
Total Preservation Time (min) 866
Recipient Details
Age 69
Indication for Transplantation Alcoholic Liver Disease Intensive care stay (days) 1
Total Hospital Stay (days) 51 Model for early allograft function score 3 5.2 Early Allograft Dysfunction 4 None Day 7 bilirubin
Day 7 INR
Peak ALT day 1 to 7
29 µmol/L 1.3
107 U/L
References
1. Watson CJE, Kosmoliaptsis V, Pley C, et al. Observations on the ex situ perfusion of livers for transplantation. Am J Transplant. 2018;18(8):2005–2020.
2. Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783–790.
3. Pareja E, Cortes M, Hervás D, et al. A score model for the continuous grading of early allograft dysfunction severity. Liver Transpl. 2015;21(1):38–46.
4. Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl.
2010;16(8):943–949.
