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.
After the detailed evaluation resection can be limited to an extent which is oncologically radical enough (1% remnant liver tissue/kg) and spares parenchyma which can ensure survival yet. With careful preoperative examination mortality can be reduced even to reach zero.
The rate of biliary complications met the international reviews. Risk factors for biliary complications were cholangitis, hepatic artery thrombosis and stenosis, high rate of intraoperative blood transfusions, and acute rejection. Biliary complications frequently associated with the initial poor function of the transplanted graft. Early biliary complications have a negative impact on patient survival, while late complications influence a decreased quality of life. Biliary complications were treated mostly by interventional radiologic procedures.
The living related donor mortality after liver donation could occur as a result of postoperative cardiovascular and thromboembolic complication; which could be minimized by detailed preoperative assessment of the living donor. The preoperative functional tests evaluate the physiological reserve or identify the living donors with limited response to the surgical stress. Based on the results of CT volumetry, MRI and liver functional reserve capacity test (indocyanine green retention ratio) the liver resection can be done safely. The preoperative cytochrome P enzymes tests of donors identify the drugs with abnormal metabolism. Balanced anesthesia combined with thoracic epidural anesthesia is done with liver safe, renal safe and ischemic preconditioning drugs. Normovolemic state is maintained with physiologic extrahepatic perfusion and oxygenation conditions. The central venous and hepatic artery pressure is reduced with the guarantee of optimal hepatic perfusion-oxygenation and better liver resection condition. Intraoperative thrombosis prophylaxis is performed with sequential compression device. After liver resection the donor morbidity can be reduced, effective analgesia, thrombosis prophylaxis, liver safe drug therapy and a tight monitoring. Before the first postoperative mobilization a deep vein Doppler ultrasound control is proposed.
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