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Vasodilation During Normothermic Machine Perfusion; Preventing the No-Reflow Phenomena.

In their study entitled “Comparison of BQ123, Epoprostenol, and Verapamil as Vasodilators During Normothermic Ex Vivo Liver Machine Perfusion,” the authors discuss the effect of vasodilation during machine perfusion in a pig transplantation model. This topic is very relevant to the field, as machine preservation is rapidly emerging as an effective preservation technology and very little is known about the perfusion conditions (medications, nutrients, supplements, etc.) enabling optimal graft perfusion and reconditioning. The primary end point was to identify an ideal vasodilator to regulate liver hemodynamics during normothermic machine perfusion. Theirworkbuilds on previous preliminarybenchwork showing that optimal vasodilation can have profound consequences on graft injury. In their work, they tested the effect of 3 different vasodilators on liver function during perfusion and after transplantation using a perfusate based on Steen solution and washed red cells similar to ongoing clinical trials. The authors compared BQ123, an endothelin-1 receptor antagonist; verapamil, a nondihydropyridine calcium channel antagonist; and epoprostenol (prostacyclin). The authors concluded that BQ123 and verapamil lead to higher hepatic artery flow and reduced parenchymal injury during perfusion and in the posttransplant period compared to epoprostenol. As mentioned in the study design limitations, this study was performed on donation after brain death (DBD) donor Yorkshire pigs. The effect of vasodilation, whereas not insignificant in DBD organs, is known to be more central during perfusion of donation after cardiocirculatory death (DCD) grafts. Studies evaluating ideal hepatic vascular vasodilation would be better suited to use such grafts as a study model. Another limitation of this study is represented by the overall short total preservation time (2 hours of cold ischemia time + 3 hours of machine preservation). This total preservation time is shorter than the average preservation time encountered in clinical practice. Furthermore, a longer preservation