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Viability assessment machine perfusion

Yvonne de Vries, Alix P M Matton, Maarten W N Nijsten, Maureen J M Werner, Aad P van den Berg, Marieke T de Boer, Carlijn I Buis, Masato Fujiyoshi, Ruben H J de Kleine, Otto B van Leeuwen, Peter Meyer, Marius C van den Heuvel, Vincent E de Meijer, Robert J Porte
Ex situ dual hypothermic oxygenated machine perfusion (DHOPE) and normothermic machine perfusion (NMP) of donor livers may have a complementary effect when applied sequentially. While DHOPE resuscitates the mitochondria and increases hepatic ATP content, NMP enables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE, NMP requires a perfusion solution with an oxygen carrier, for which red blood cells (RBC) have been used in most series. RBC, however, have limitations and cannot be used cold...
December 26, 2018: American Journal of Transplantation
Dániel Wettstein, Mátyás Hamar, Orsolya Cseprekál, Szabolcs József Tóth, Balázs Rózsa, Ádám Remport, Zoltán Máthé
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...
November 2018: Orvosi Hetilap
R Yoshikawa, H Obara, N Matsuno, N Morito, M Gouchi, M Otani, T Shonaka, H Takahashi, S Enosawa, T Hirano, H Furukawa
BACKGROUND: Machine perfusion (MP) techniques are expected to prove useful for preserving the organ viability and recovering organ function for organ transplantation. Furthermore, an accurate assessment of organ viability using MP is important for expanding the donor criteria. In this study, an ex vivo reperfusion model (ERM) simulating transplantation using diluted autologous blood under normothermic conditions was evaluated for its utility of MP under subnormothermic conditions for livers donated after cardiac death (DCD)...
November 2018: Transplantation Proceedings
Hynek Mergental, Barnaby T F Stephenson, Richard W Laing, Amanda J Kirkham, Desley A H Neil, Lorraine L Wallace, Yuri L Boteon, Jeannette Widmer, Ricky H Bhogal, M Thamara P R Perera, Amanda Smith, Gary M Reynolds, Christina Yap, Stefan G Hübscher, Darius F Mirza, Simon C Afford
Increased use of high-risk allografts is critical to meet the demand for liver transplantation. We aimed to identify criteria predicting viability of organs, currently declined for clinical transplantation, using functional assessment during normothermic machine perfusion (NMP). Twelve discarded human livers were subjected to NMP following static cold storage. Livers were perfused with a packed red cell-based fluid at 37°C for 6 hours. Multilevel statistical models for repeated measures were employed to investigate the trend of perfusate blood gas profiles and vascular flow characteristics over time and the effect of lactate-clearing (LC) and non-lactate-clearing (non-LC) ability of the livers...
October 2018: Liver Transplantation
J Kim, M A Zimmerman, J C Hong
The availability of marginal liver grafts represents a potential resource of orthotopic liver transplantation (OLT) in the era of organ shortage. However, an increased susceptibility to ischemia-reperfusion injury results in the increased risk for primary nonfunction and biliary complications. Novel methods of organ preservation and resuscitation are under investigation to improve outcomes of OLT with the use of marginal grafts. Machine perfusion (MP) in OLT is categorized based on the temperature setting. Hypothermic MP minimizes oxygen demand and uses single- or dual-vessel infusion with or without oxygenation...
October 2018: Transplantation Proceedings
Wenke Markgraf, Philipp Feistel, Christine Thiele, Hagen Malberg
The lack of donor grafts is a severe problem in transplantation medicine. Hence, the improved preservation of existing and the usage of organs that were deemed untransplantable is as urgent as ever. The development of novel preservation techniques has come into focus. A promising alternative to traditional cold storage is normothermic machine perfusion (NMP), which provides the benefit of improving the organs' viability and of assessing the organs' status under physiological conditions. For this purpose, methods for evaluating organ parameters have yet to be developed...
October 25, 2018: Biomedizinische Technik. Biomedical Engineering
H Abudhaise, B R Davidson, P DeMuylder, T V Luong, B Fuller
INTRODUCTION: Hypothermic machine perfusion (HMP) is increasingly investigated as a means to assess liver quality, but data on viability markers is inconsistent and the effects of different perfusion routes and oxygenation on perfusion biomarkers are unclear. METHODS: This is a single-centre, randomised, multi-arm, parallel study using discarded human livers for evaluation of HMP using arterial, oxygen-supplemented venous and non-oxygen-supplemented venous perfusion...
2018: PloS One
Otto B van Leeuwen, Vincent E de Meijer, Robert J Porte
No abstract text is available yet for this article.
October 2018: Liver Transplantation
Zoltan Czigany, Isabella Lurje, Rene H Tolba, Ulf P Neumann, Frank Tacke, Georg Lurje
In the face of a critical organ shortage in the Western world, various strategies are employed to expand the donor pool for orthotopic liver transplantation (OLT). Among them is the transplantation of organs from extended criteria donors, a valuable source of liver allografts, however, characterized by potential risks for post-OLT complications and inferior outcomes. In recent years, machine perfusion (MP) of the explanted donor liver as well as regional perfusion techniques has witnessed significant advancements...
August 20, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Kumar Jayant, Isabella Reccia, A M James Shapiro
Nowadays liver transplantation is considered as the treatment of choice, however, the scarcity of suitable donor organs limits the delivery of care to the end-stage liver disease patients leading to the death while on the waiting list. The advent of ex-situ normothermic machine perfusion (NMP) has emerged as an alternative to the standard organ preservation technique, static cold storage (SCS). The newer technique promises to not only restore the normal metabolic activity but also attempt to recondition the marginal livers back to the pristine state, which are otherwise more susceptible to ischemic injury and foster the poor post-transplant outcomes...
August 20, 2018: Expert Review of Gastroenterology & Hepatology
Yuri L Boteon, Richard W Laing, Andrea Schlegel, Loraine Wallace, Amanda Smith, Joseph Attard, Ricky H Bhogal, Desley Ah Neil, Stefan Hübscher, M Thamara Pr Perera, Darius F Mirza, Simon C Afford, Hynek Mergental
BACKGROUND: Hypothermic oxygenated perfusion and normothermic perfusion are seen as distinct techniques of ex-situ machine perfusion of the liver. We aimed to demonstrate the feasibility of combining both techniques and whether it would improve functional parameters of donor livers into transplant standards. METHODS: Ten discarded human donor livers had either 6 hours of normothermic perfusion (n=5) or 2 hours of hypothermic oxygenated perfusion followed by 4 hours of normothermic perfusion (n=5)...
July 30, 2018: Liver Transplantation
Kumar Jayant, Isabella Reccia, Francesco Virdis, A M James Shapiro
Introduction: The success of liver transplantation has been limited by the unavailability of suitable donor livers. The current organ preservation technique, i.e., static cold storage (SCS), is not suitable for marginal organs. Alternatively, normothermic machine perfusion (NMP) promises to recreate the physiological environment and hence holds promise for the better organ preservation. The objective of this systematic review is to provide an overview of the safety, benefits, and insight into the other potential useful parameters of NMP in the liver preservation...
2018: HPB Surgery: a World Journal of Hepatic, Pancreatic and Biliary Surgery
Cristiano Quintini, Paulo N Martins, Shimul Shah, Mary Killackey, Alan Reed, James Guarrera, David A Axelrod
The pervasive shortage of deceased donor liver allografts contributes to significant waitlist mortality despite efforts to increase organ donation. Ex vivo liver perfusion appears to enhance preservation of donor organs, extending viability and potentially evaluating function in organs previously considered too high risk for transplant. These devices pose novel challenges for organ allocation, safety, training, and finances. This white paper describes the American Society of Transplant Surgeons' belief that organ preservation technology is a vital advance, but its use should not change fundamental aspects of organ allocation...
August 2018: American Journal of Transplantation
Annemarie Weissenbacher, Letizia Lo Faro, Olga Boubriak, Maria F Soares, Ian S Roberts, James P Hunter, Daniel Voyce, Nikolay Mikov, Andrew Cook, Rutger J Ploeg, Constantin C Coussios, Peter J Friend
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ use, and improved transplant logistics. Eleven clinically declined kidneys were perfused normothermically, with 6 being from donors after brain death (median cold ischemia time 33 ± 36.9 hours) and 5 being from donors after circulatory death (36.2 ± 38.3 hours). Three kidneys were perfused using Ringer's lactate to replace excreted urine volume, and 8 kidneys were perfused using urine recirculation to maintain perfusate volume without fluid replenishment...
January 2019: American Journal of Transplantation
Matyas Hamar, Markus Selzner
PURPOSE OF REVIEW: Machine perfusion is a novel strategy to decrease preservation injury, improve graft assessment, and increase organ acceptance for transplantation. This review summarizes the current advances in ex-vivo machine-based kidney preservation technologies over the last year. RECENT FINDINGS: Ex-vivo perfusion technologies, such as hypothermic and normothermic machine perfusion and controlled oxygenated rewarming, have gained high interest in the field of organ preservation...
June 2018: Current Opinion in Organ Transplantation
David Nasralla, Constantin C Coussios, Hynek Mergental, M Zeeshan Akhtar, Andrew J Butler, Carlo D L Ceresa, Virginia Chiocchia, Susan J Dutton, Juan Carlos García-Valdecasas, Nigel Heaton, Charles Imber, Wayel Jassem, Ina Jochmans, John Karani, Simon R Knight, Peri Kocabayoglu, Massimo Malagò, Darius Mirza, Peter J Morris, Arvind Pallan, Andreas Paul, Mihai Pavel, M Thamara P R Perera, Jacques Pirenne, Reena Ravikumar, Leslie Russell, Sara Upponi, Chris J E Watson, Annemarie Weissenbacher, Rutger J Ploeg, Peter J Friend
Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time...
May 2018: Nature
Danielle Detelich, James F Markmann
PURPOSE OF REVIEW: Normothermic machine perfusion (NMP) is an emerging technology for liver preservation. Early clinical results demonstrate beneficial effects in reconditioning high-risk grafts. This review discusses the role of normothermic perfusion as a tool to assess graft viability and as a platform for graft intervention and modification. RECENT FINDINGS: The potential benefits of NMP extend far beyond organ reconditioning. Recent pilot studies have identified clinically relevant viability criteria, which now require validation in large randomized control trials prior to implementation...
June 2018: Current Opinion in Organ Transplantation
Shamik Dholakia, Elisabeth Royston, Edward J Sharples, Visesh Sankaran, Rutger J Ploeg, Peter J Friend
The concept of organ preservation by perfusion dates back to the mid-19th century. Innovations since then have included temperature regulation, perfusion fluid composition and various pumping systems. Advances made in liver, heart and kidney machine preservation are now contributing to increased graft utilisation, assessment of graft viability and potentially improved graft survival. Pancreas transplantation has not benefitted to the same extent from the application of perfusion technology, although the need is just as great...
July 2018: Transplantation Reviews
Carlo D L Ceresa, David Nasralla, Wayel Jassem
Purpose of Review: This review aims to introduce the concept of normothermic machine perfusion (NMP) and its role in liver transplantation. By discussing results from recent clinical studies and highlighting the potential opportunities provided by this technology, we aim to provide a greater insight into NMP and the role it can play to enhance liver transplantation. Recent Findings: NMP has recently been shown to be both safe and feasible in liver transplantation and has also demonstrated its superiority to traditional cold storage in terms of early biochemical liver function...
2018: Current Transplantation Reports
Christopher J E Watson, Ina Jochmans
Purpose of Review: The purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers. Recent Findings: In both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo...
2018: Current Transplantation Reports
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