FIGURE 1.

Perfusate and tissue markers of liver function before and after liver splitting during normothermic ex vivo machine perfusion of human livers. A, Lactate from packed red cells was rapidly cleared at the start of perfusion and maintained at a low level until 120 h of ex vivo perfusion. This was followed by a rapid decline parallel to death of both grafts. The lactate from individual grafts was sampled directly from respective hepatic veins. B, Bile was produced at a constant rate by the whole liver until splitting and then by each lobe individually. Bile flow slowed and ceased first in the left lobe and then the right lobe as the graft reached 120 h. C, Alanine aminotransferase (ALT) remained high throughout ex vivo perfusion. D and E, Indirect (international normalized ratio [INR]) and direct markers (factor V) of liver synthetic function demonstrated functional liver during perfusion before ceasing from 120 h of perfusion. F–H, Hematoxylin and eosin staining of core biopsies taken presplitting (F), and postsplitting from the right graft (G) and the left graft (H) (original objective ×20). In all sections, there are occasional apoptotic hepatocytes but no evidence of perivenular necrosis or loss of hepatocyte cohesion consistent with liver viability before and after splitting.