Cytokine adsorption during normothermic machine perfusion of porcine livers

Normothermic machine perfusion (NMP) enables the evaluation of donor liver viability and offers the potential for graft resuscitation prior to transplantation. However, the impact of NMP-induced inflammatory responses on liver allografts remains unclear, with possible consequences for graft function, rejection rates, and recipient survival. The use of Cytosorb for cytokine adsorption has shown promise in reducing inflammation during cardiopulmonary bypass and in critically ill patients with multi-organ failure. This study aimed to investigate the effect of the Cytosorb adsorber on liver grafts during NMP. Livers obtained from eleven pigs underwent NMP for 6 hours without cytokine adsorption (control group) or with cytokine adsorption (cytosorb group). NMP with cytosorb therapy showed a reduction of proinflammatory cytokines and danger-associated molecular patterns including IL6 (3308.44 vs. 1563.80; p=0.030), IL1β (277.10 vs. 83.27; p=0.126), IL18 (6838.79 vs. 383.96; p=0.004) and HMGB1 (2442.20 vs. 74.17: p=0.004) after 6 hours. In line with these results the liver injury was significantly reduced measured by AST values (2389.20 vs. 1319.00; p=0.034). While bile production, as a marker of liver function, remained stable with CytoSorb use, there was a positive trend in lactate clearance. Our data suggest that removing pro-inflammatory mediators from the perfusate, potentially decreases inflammation and reduces liver injury. Thus, incorporating adsorptive therapies like CytoSorb during NMP could be a promising strategy to enhance graft viability and transplant outcomes.

Publication History

Article published online:
20 January 2025