Real-Time Assessment of Liver Function During Sub-Normothermic Machine Perfusion by a Non-Invasive 13C Based Test

Background: Assessment of liver quality during machine perfusion (MP) is under intensive investigation. Gold standard methods either are of limited validity or evaluation is time-consuming. Hence, herein we investigate a novel real-time method to estimate liver function during sub-normothermic MP. Methods Three healthy porcine livers and one non-allocable human liver were subjected to 24h of SNMP with either Custodiol® or Custodiol MP as perfusate. Additional to liver enzymes, Flavin mononucleotide (FMN) and High-mobility group box 1 (HMGB-1) as well-established markers of liver quality, a novel 13 C-Methacetin based method was evaluated. Readouts of ϭ 13 CO 2 plots generated by the 13 CORLab Prototype were calculated and compared to established parameters. Results The newly established method mirrored the pathological findings as well as the increasing changes in liver enzymes, HMGB-1 and FMN levels bearing the advantage of being a real-time, non-invasive test which is applicable on site. Conclusion This novel method is an easy to implement and reliable tool for quick on-site estimation of liver function during liver SNMP.