Reconditioning of fatty livers for transplantation increased survival of recipients in a rat model

Fatty livers are very sensitive to ischemia-reperfusion and cold preservation-related injuries, which makes them unacceptable for liver transplantation. We hypothesized that removal of the excess fat storage from fatty livers can restore their ability to undergo liver transplantation. We obtained fatty livers from rats fed a choline and methionine-deficient diet (CMDD) for 6 wk, stored them in cold hetastarch-free University of Wisconsin solution for 6 h, and transplanted them into normal recipient rats. While recipient rats had a 90% rate of survival after transplantation of control normal "lean" livers, they all died when receiving CMDD rat livers. If CMDD rats were returned to a normal diet for 3 or 7 days prior to donating livers, effectively reducing the fat content of the livers by 33% and 85%, respectively, the recipients survived at rates similar to the controls. Furthermore, we found that it is possible to eliminate excess fat storage from fatty livers by short-term perfusion of fatty livers ex vivo. These results support the notion that liver perfusion could be used to recondition fatty livers and make them suitable for transplantation.