Application of Mesenchymal Stem Cells During Machine Perfusion: An Emerging Novel Strategy for Organ Preservation

Although solid organ transplantation remains the definitive management for patients with end-stage organ failure, this ultimate treatment has been limited by the number of acceptable donor organs. Therefore, efforts have been made to expand the donor pool by utilizing marginal organs from donation after circulatory death or extended criteria donors. However, marginal organs are susceptible to ischemia-reperfusion injury (IRI) and entail higher requirements for organ preservation. Recently, machine perfusion has emerged as a novel preservation strategy for marginal grafts. This technique continually perfuses the organs to mimic the physiologic condition, allows the evaluation of pretransplant graft function, and more excitingly facilitates organ reconditioning during perfusion with pharmacological, gene, and stem cell therapy. As mesenchymal stem cells (MSCs) have anti-oxidative, immunomodulatory, and regenerative properties, mounting studies have demonstrated the therapeutic effects of MSCs on organ IRI and solid organ transplantation. Therefore, MSCs are promising candidates for organ reconditioning during machine perfusion. This review provides an overview of the application of MSCs combined with machine perfusion for lung, kidney, liver, and heart preservation and reconditioning. Promising preclinical results highlight the potential clinical translation of this innovative strategy to improve the quality of marginal grafts.

Recent advances in liver transplantation

Liver transplant is a life-saving treatment with 1-year and 5-year survival rates of 90% and 70%, respectively. However, organ demand continues to exceed supply, such that many patients will die waiting for an available organ. This article reviews for the general gastroenterologist the latest developments in the field to reduce waiting list mortality and maximise utilisation of available organs. The main areas covered include legislative changes in organ donation and the new ‘opt-out’ systems being rolled out in the UK, normothermic machine perfusion to optimise marginal grafts, a new national allocation system to maximise benefit from each organ and developments in patient ‘prehabilitation’ before listing. Current areas of research interest, such as immunosuppression withdrawal, are also summarised.

Safe use of Liver Grafts from Syphilis-Positive Donors in Liver Transplantation and Review of the Literature

Background: The growing disparity between organ availability and the number of candidates for organ transplantation has urged the use of marginal grafts including grafts from syphilis-positive donors. However, few knowledges could be acknowledged about this due to the rare data from case reports. Therefor we evaluate our data and summarize our experience of the management of liver grafts from syphilis-positive donors.Methods: From January 2015 to December 2019, 22 adult patients received liver transplantation from syphilis-positive donors while 873 patients got liver transplantation from syphilis-negative donors at our center. Given the imbalance in several baseline variables, propensity score matching was used. The outcomes were compared including complications, hospital stay, recovery of liver function and survival of the two groups and the management of the recipients was reviewed.Results: There were no differences in complications and hospital stay of the recipients after transplantation. And it showed similar trends in the liver function recovery. Patient and graft survivals were comparable to that of syphilis-negative grafts. And benzathine penicillin is effective to protect the recipients from syphilis.Conclusions: The use of liver grafts from syphilis-positive donors does not to increase the morbidity and mortality of the recipients. Also, the prophylactic theory of benzathine penicillin is helpful.

Szervkonzerválás gépi perfúzióval: új lehetőségek a hasi szervek transzplantációjában

Machine perfusion of marginal grafts might be a possible solution to organ shortage and a promising tool for reducing waiting list morbidity and mortality. In recent years, optimizing the circumstances of organ preservation prior to implantation via machine perfusion has become a hot topic of research. Machine perfusion offers a platform for organ reconditioning, assessment of cell viability and function, pharmacological preconditioning, prolongation of preservation time (ischemia time) and finally reducing graft injury. The objective of the new technology is to increase the pool of transplantable organs safely. Multicentric prospective studies have been evaluating the short and long term outcomes of different methods, however, several questions still remain unanswered. This review summarizes the recent advances in the field of machine perfusion, focusing on preclinical and clinical results. Machine perfusion seems to be a new milestone in the modern era of solid organ transplantation. Orv Hetil. 2018; 159(46): 1882–1890.