The aim of the present study was to evaluate the potential benefit of machine preservation with the Belzer MPS or HTK solution, compared to standard cold storage, after procurement of marginal livers from non-heart beating donors in an experimental pilot study. Livers from male Wistar rats (250–300 g bw) were harvested after 60 min of cardiac arrest, flushed via the portal vein and cold stored submerged in HTK for 24 h at 4 °C while other organs were subjected to oxygenated machine perfusion with HTK or BelzerÕs MPS at 5 ml/min at 4 °C. Cold perfusion of livers with the non- colloidal HTK was not compromised by the lack of oncotic agents and there was no rise in vascular resistance during the 24 h of machine preservation with HTK or the colloidal Belzer MPS. Viability of the livers was assessed after the cold preservation period by warm reperfusion in vitro. Oxygenated machine perfusion was found to significantly in- crease viability of the livers vs simple cold storage with respect to portal vascular resistance upon reperfusion, enzyme release as well as functional recovery of oxygen utilization or bile production. Moreover, tissue antigen expression of ICAM-1 or histocompatibility antigen class II could be markedly reduced by oxygenated perfusion preservation as compared to cold storage. It is concluded that predamaged organs should preferably be preserved by oxygenated machine perfusion thus minimizing functional alterations and immunogenicity of the graft. In this setup HTK appeared equally effective as Belzer’s MPS for machine preservation.

Preservation injury during ischemic storage remains a notable problem in human liver trans plantation resulting in initial dysfunction of the grafts. In face of the increasing shortage of donor organs for clinical transplantation, the donor acceptance criteria for liver retrieval have been expanded towards inclusion of older donors and the use of so called marginal organs (e.g., steatotic livers). Non-heart beating donors (NHBD) may represent an alternative supply of organs and some centers have started programs for the procurement of livers from NHBD’s [2,5,27]. However, preservation of organ viability during cold storage of these marginal grafts is particularly endangered by the apparently reduced ischemic tolerance of the latter [2,19].

With respect to renal transplantation it could be shown that viability of NHBD-kidneys was particularly improved when conventional cold storage was replaced by continuous hypothermic perfusion preservation on recirculation machine devices [15,26,31].