LAUSR

INTRODUCTION Normothermic machine perfusion (NMP) provides a platform for drug-delivery. However, pharmacological considerations for therapeutics delivered during NMP are scarcely reported. We aimed to demonstrate the ability of NMP as a platform for pharmacological testing, using a drug which increases metabolism (2,4-Dinitrophenol; DNP) as an example therapeutic. METHODS We performed 25 hours of NMP on human livers which had been declined for transplant due to steatosis (n=7). Three livers received a DNP bolus, three were controls, and one received a DNP infusion. RESULTS Toxicity studies revealed DNP delivery was safe, without hepatotoxic effects. Liver surface temperature was increased in the DNP group (P=0.046), but no livers suffered hyperthermia - the mechanism of DNP toxicity in vivo. Pharmacokinetic studies revealed DNP elimination with first-order kinetics and 7.7 hour half-life (95% CI=5.1-15.9hrs). Clearance of DNP in bile was negligible. As expected, DNP significantly increased oxygen consumption (P=0.023); this increase was closely correlated with perfusate DNP concentration (r2 =0.975; P=0.002) and the effect was lost as DNP was eliminated by the liver. A DNP infusion rate, calculated using our pharmacokinetic data, successfully maintained perfusate DNP concentration. DISCUSSION Detailed pharmacological testing can be performed during NMP. Our therapeutic (DNP) is rapidly eliminated by the ex-vivo liver, meaning the drug effect of increased metabolism is only transient. This demonstrates the importance of assessing pharmacokinetics when delivering therapeutics during NMP, especially for prolonged perfusion of organs with established roles in drug elimination. Rigorous pharmacological testing is needed to unlock the potential of NMP as a clinical drug-delivery platform.