Transplant Direct. 2025 Nov 7;11(12):e1876. doi: 10.1097/TXD.0000000000001876. eCollection 2025 Dec.
ABSTRACT
BACKGROUND: Several viability tests, including lactate clearance and bile production, are used to evaluate livers during normothermic machine perfusion (NMP). However, specific cutoff values and therapeutic consequences vary significantly. The noninvasive 13C-methacetin liver function breath test (LiMAx) was developed to measure the actual liver function capacity. This might also provide useful insights into graft function during NMP.
METHODS: Therefore, we used an established porcine model of prolonged static cold storage (pSCS) and subsequent NMP for additional functional monitoring with the LiMAx test. Livers obtained from 9 pigs underwent NMP for 6 h directly after procurement (control group) or after 20 h of SCS (pSCS). After 6 h of NMP, the LiMAx test was performed using a liver weight-adjusted dose of 13C-methacetin.
RESULTS: After pSCS, transaminase and cholestasis parameters were found to be elevated in the perfusate and reduced lactate clearance was measured. Bile analyses further revealed reduced bile production and elevated glucose concentrations. In line with these results, the LiMAx test also showed significantly reduced values compared with the control group, with a mean value of 57.0 µg/kg/h compared with 182.0 µg/kg/h in the control group (P = 0.032).
CONCLUSIONS: Therefore, we suggest the LiMAx test as a novel diagnostic tool for evaluating donor organs during NMP.
PMID:41209479 | PMC:PMC12594296 | DOI:10.1097/TXD.0000000000001876
