Organ Preservation in Liver Transplantation

2018 ◽  
Vol 38 (03) ◽  
pp. 260-269 ◽  
Author(s):  
Alberto Zanetto ◽  
Francesco Russo ◽  
Giacomo Germani ◽  
Patrizia Burra
Keyword(s):  
Liver Transplantation ◽  
Cold Storage ◽  
Organ Preservation ◽  
Clinical Applications ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Donor Pool ◽  
Number Of Patients ◽  
Pros And Cons ◽  
Donor Shortage

AbstractThe discrepancy between the number of patients awaiting liver transplantation and the number of available donors has become a key issue in the transplant setting. Various strategies to cope with the donor shortage problem and to increase the use of suboptimal grafts have been explored. Machine perfusion has been applied ex situ to liver grafts in the effort to improve static cold-storage preservation. If a more extensive application of this technology confirms the preliminary results, machine perfusion will become crucial in increasing the donor pool as well as improving recipients' outcomes. In this review, the authors focused on the evolution of machine perfusion, from the first animal experiences to the latest evidence in humans, highlighting the pros and cons as well as the potential clinical applications of various types of machine.

scholarly journals Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation

2021 ◽  
Vol 7 (3) ◽  
pp. e666
Author(s):  
Adam M. Thorne ◽  
Veerle Lantinga ◽  
Silke Bodewes ◽  
Ruben H. J. de Kleine ◽  
Maarten W. Nijkamp ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Split Liver Transplantation ◽  
Split Liver

scholarly journals A Novel Oxygen Carrier (M101) Attenuates Ischemia-Reperfusion Injuries during Static Cold Storage in Steatotic Livers

2021 ◽  
Vol 22 (16) ◽  
pp. 8542
Author(s):  
Njikem Asong-Fontem ◽  
Arnau Panisello-Rosello ◽  
Alexandre Lopez ◽  
Katsunori Imai ◽  
Franck Zal ◽  
...  
Keyword(s):  
Cold Storage ◽  
Organ Preservation ◽  
Marine Invertebrate ◽  
Ischemia Reperfusion ◽  
Oxygen Carrier ◽  
Graft Function ◽  
Ex Situ ◽  
Zucker Rats ◽  
Innovative Strategies ◽  
Lactate Levels

The combined impact of an increasing demand for liver transplantation and a growing incidence of nonalcoholic liver disease has provided the impetus for the development of innovative strategies to preserve steatotic livers. A natural oxygen carrier, HEMO2life®, which contains M101 that is extracted from a marine invertebrate, has been used for static cold storage (SCS) and has shown superior results in organ preservation. A total of 36 livers were procured from obese Zucker rats and randomly divided into three groups, i.e., control, SCS-24H and SCS-24H + M101 (M101 at 1 g/L), mimicking the gold standard of organ preservation. Ex situ machine perfusion for 2 h was used to evaluate the quality of the livers. Perfusates were sampled for functional assessment, biochemical analysis and subsequent biopsies were performed for assessment of ischemia-reperfusion markers. Transaminases, GDH and lactate levels at the end of reperfusion were significantly lower in the group preserved with M101 (p < 0.05). Protection from reactive oxygen species (low MDA and higher production of NO2-NO3) and less inflammation (HMGB1) were also observed in this group (p < 0.05). Bcl-1 and caspase-3 were higher in the SCS-24H group (p < 0.05) and presented more histological damage than those preserved with HEMO2life®. These data demonstrate, for the first time, that the addition of HEMO2life® to the preservation solution significantly protects steatotic livers during SCS by decreasing reperfusion injury and improving graft function.

scholarly journals Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials

2020 ◽  
Vol 40 (03) ◽  
pp. 264-281 ◽  
Author(s):  
E. Bonaccorsi-Riani ◽  
I.M.A. Brüggenwirth ◽  
J.E. Buchwald ◽  
S. Iesari ◽  
P.N. Martins
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Correct Trial ◽  
Gold Standard Method ◽  
Liver Preservation ◽  
Mature Phase ◽  
Normothermic Machine Perfusion ◽  
Human Livers

AbstractMachine perfusion (MP) preservation is potentially one of the most significant improvements in the field of liver transplantation in the last 20 years, and it has been considered a promising strategy for improved preservation and ex situ evaluation of extended criteria donor (ECD) organs. However, MP preservation adds significant cost and logistical considerations to liver transplantation. MP protocols are mainly classified according to the perfusion temperature with hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) being the two categories most studied so far. After extensive preclinical work, MP entered the clinical setting, and there are now several studies that demonstrated feasibility and safety. However, because of the limited quality of clinical trials, there is no compelling evidence of superiority in preservation quality, and liver MP is still considered experimental in most countries. MP preservation is moving to a more mature phase, where ongoing and future studies will bring new evidence in order to confirm their superiority in terms of clinical outcomes, organ utilization, and cost-effectiveness. Here, we present an overview of all preclinical MP studies using discarded human livers and liver MP clinical trials, and discuss their results. We describe the different perfusion protocols, pitfalls in MP study design, and provide future perspectives. Recent trials in liver MP have revealed unique challenges beyond those seen in most clinical studies. Randomized trials, correct trial design, and interpretation of data are essential to generate the data necessary to prove if MP will be the new gold standard method of liver preservation.

scholarly journals Ex Situ Liver Machine Perfusion as an Emerging Graft Protective Strategy in Clinical Liver Transplantation

2019 ◽  
Vol 103 (10) ◽  
pp. 2003-2011
Author(s):  
Arash Nickkholgh ◽  
Mohammadsadegh Nikdad ◽  
Saeed Shafie ◽  
Sepehr Abbasi Dezfouli ◽  
Arianeb Mehrabi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Protective Strategy ◽  
Liver Machine Perfusion

Complications following Split-Liver Transplantation: A Pediatric Case Study

2002 ◽  
Vol 12 (2) ◽  
pp. 125-128
Author(s):  
Susan K. Jaskowski Phillips
Keyword(s):  
Liver Transplantation ◽  
Postoperative Complications ◽  
Organ Donor ◽  
Unknown Etiology ◽  
Donor Pool ◽  
Split Liver Transplantation ◽  
Split Liver ◽  
Donor Shortage ◽  
Cadaveric Organ

Liver transplantation using split and reduced livers has helped to expand the donor pool for pediatric patients in the presence of a severe cadaveric organ donor shortage. However, this technique has been associated with an increased rate of postoperative complications. The purpose of this paper is to review a case report of postoperative complications experienced by a pediatric patient following split-liver transplantation for fulminant hepatic failure of unknown etiology.

scholarly journals Ex situ machine perfusion strategies in liver transplantation

2019 ◽  
Vol 70 (1) ◽  
pp. 203-205 ◽  
Author(s):  
Vincent Erwin de Meijer ◽  
Masato Fujiyoshi ◽  
Robert Jack Porte
Keyword(s):  
Liver Transplantation ◽  
Ex Situ ◽  
Machine Perfusion

scholarly journals The transportable oxygenated machine perfusion Airdrive ® , an innovative approach to safely expand the donor pool for liver transplantation

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e555-e556
Author(s):  
P. Compagnon ◽  
H. Hentati ◽  
M. Disabato ◽  
E. Lesveque ◽  
J. Cohen ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Innovative Approach ◽  
Machine Perfusion ◽  
Donor Pool

scholarly journals A simple ex vivo model of human renal allograft preservation using the gonadal vein

2019 ◽  
Vol 101 (8) ◽  
pp. 609-616
Author(s):  
WP Ries ◽  
Y Marie ◽  
K Patel ◽  
C Turnbull ◽  
TB Smith ◽  
...  
Keyword(s):  
Cold Storage ◽  
Organ Preservation ◽  
Caspase 3 ◽  
Ex Vivo ◽  
Human Model ◽  
Machine Perfusion ◽  
Flow Conditions ◽  
Ex Vivo Perfusion ◽  
Gonadal Vein ◽  
Hypothermic Machine Perfusion

Introduction Hypothermic machine perfusion, an organ preservation modality, involves flow of chilled preservation fluid through an allograft’s vasculature. This study describes a simple, reproducible, human model that allows for interrogation of flow effects during ex vivo organ perfusion. Materials and methods Gonadal veins from deceased human renal allografts were subjected to either static cold storage or hypothermic machine perfusion for up to 24 hours. Caspase-3, Krüppel-like factor 2 expression and electron microscopic analysis were compared between ‘flow’ and ‘no-flow’ conditions, with living donor gonadal vein sections serving as negative controls. Results The increase in caspase-3 expression was less pronounced for hypothermic machine-perfused veins compared with static cold storage (median-fold increase 1.2 vs 2.3; P < 0.05). Transmission electron microscopy provided ultrastructural corroboration of endothelial cell apoptosis in static cold storage conditions. For static cold storage preserved veins, Krüppel-like factor 2 expression diminished in a time-dependent manner between baseline and 12 hours (P < 0.05) but was abrogated and reversed by hypothermic machine perfusion (P < 0.05). Conclusions Our methodology is a simple, reproducible and successful model of ex vivo perfusion in the context of human organ preservation. To demonstrate the model’s utility, we establish that two widely used markers of endothelial health (caspase-3 and Krüppel-like factor 2) differ between the flow and no-flow conditions of the two predominant kidney preservation modalities. These findings suggest that ex vivo perfusion may mediate the induction of a biochemically favourable endothelial niche which may contribute tohypothermic machine perfusion’s association with improved renal transplantation outcomes.

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