The ability to preserve metabolically active livers ex vivo for 1 week or more could allow repair of poor-quality livers that would otherwise be declined for transplantation. Current approaches for normothermic perfusion can preserve human livers for only 24 h. Here we report a liver perfusion machine that integrates multiple core physiological functions, including automated management of glucose levels and oxygenation, waste-product removal and hematocrit control. We developed the machine in a stepwise fashion using pig livers. Study of multiple ex vivo parameters and early phase reperfusion in vivo demonstrated the viability of pig livers perfused for 1 week without the need for additional blood products or perfusate exchange. We tested the approach on ten injured human livers that had been declined for transplantation by all European centers. After a 7-d perfusion, six of the human livers showed preserved function as indicated by bile production, synthesis of coagulation factors, maintained cellular energy (ATP) and intact liver structure.

将代谢活跃的肝脏离体保存 1 周或更长时间的能力可以修复质量差的肝脏，否则这些肝脏会被拒绝进行移植。目前的常温灌注方法只能将人类肝脏保存 24 小时。在这里，我们报告了一种肝脏灌注机，它集成了多种核心生理功能，包括葡萄糖水平和氧合的自动管理、废物清除和血细胞比容控制。我们使用猪肝逐步开发了这台机器。对多个离体参数和体内早期再灌注的研究表明，在不需要额外的血液制品或灌注液交换的情况下，灌注 1 周的猪肝的活力。我们在所有欧洲中心都拒绝移植的十个受伤的人类肝脏上测试了这种方法。