Organ transplantationAttempt to Rescue Discarded Human Liver Grafts by End Ischemic Hypothermic Oxygenated Machine Perfusion
Section snippets
Human Livers
Between 2006 and 2010, we studied 27 livers that could not be allocated by Eurotransplant and were discarded for the following reasons: steatosis > 30% (n = 14), not usable DCD (n = 7), donor malignancy (n = 4), failed (re)allocation (n = 1), atheromatosis (n = 1), poor perfusion (n = 1) or rising liver function tests (n = 1) (Table 1). This protocol was approved by our ethics committee and endorsed by the Belgian Liver Intestinal Committee.
Preservation
All livers included in the study were procured
Results
Both HMP and SCS groups had similar donor characteristics as well as values of AST, alanine aminotransferase, bilirubin, and sodium. The percentages of DCD and steatotic livers were not different between HMP (36% and 55%, respectively) and SCS (58% and 36%; P = .49 and .41, respectively). Total cold ischemia time was not different between HMP (17 hours, 28 minutes ± 3 hours, 42 minutes) and SCS (15 hours, 58 minutes ± 2 hours, 47 minutes) livers (P = .27; Table 3).
During warm reperfusion, AST
Discussion
This study investigated the possibility to ameliorate cold-preserved marginal human liver grafts by subjecting them to a short 4-hour period of oxygenated HMP. In contrast with other transplant animal experiments, no clear benefits were demonstrated in our ex vivo rewarming experimental setting.12, 13, 14
During warm perfusion, concentrations of AST and LDH were lower in livers that had been machine perfused compared with those that had been cold-stored only. This observation possibly points to
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Cited by (21)
Challenges to liver transplantation and strategies to improve outcomes
2015, GastroenterologyCitation Excerpt :In an additional study, discarded livers were randomly stored in the cold or perfused for 4 hours using the machine system (total preservation time of approximately 16 hours). The degree of reperfusion injury was tested through subsequent ex vivo perfusion of liver grafts at body temperature with diluted red blood cells for 2 hours showing reduced aspartate transaminase and lactate dehydrogenase release when compared with cold stored livers, but no morphological difference could be identified.140 Another technique of machine-mediated cold liver perfusion involves a hyperbaric oxygenated perfusate delivered through the portal vein only at low pressure 1 to 2 hours before implantation.
"resuscitation" of marginal liver allografts for transplantation with machine perfusion technology
2014, Journal of HepatologyHOPE for human liver grafts obtained from donors after cardiac death
2014, Journal of HepatologyCitation Excerpt :The worldwide experience in human machine liver perfusion is very scarce, and there has been no report to date on transplantation after ex situ machine perfusion of human DCD livers. Current research remains limited to ex situ perfusion of DCD livers without further implantation [38–40], or to machine perfusion of organs derived from brain death donors either by hypothermic perfusion without active oxygenation [15] or by normothermic perfusion for several hours with blood (Friend P. 15th March 2013, BBC news). The Barcelona group has been the only group up to now, who performed in situ perfusion (NECMO) and transplantation in Maastricht II donors [41].
Activation of CCL21-GPR174/CCR7 on cardiac fibroblasts underlies myocardial ischemia/reperfusion injury
2022, Frontiers in GeneticsMachine Perfusion: Cold versus Warm, versus NeitherUpdate on Clinical Trials
2020, Seminars in Liver Disease
This research was funded with the Fund for Scientific Research Flanders (FWO) grant No. G.0577.08 and No. G.0619.09 and an unrestricted grant form Astellas and Roche, Belgium. Jacques Pirenne and Diethard Monbaliu are holders of a CAF (Belgium Central Department for Plasma Fractionation) chair for abdominal transplant surgery. Katrien Vekemans is a postdoctoral researcher of the “Fund for Scientific Research Flanders.”