Advantages of Celsior Solution in Graft Preservation from Non-Heart-Beating Donors in a Canine Liver Transplantation Model

Ohwada, Susumu; Saito, Yutaka; Aiba, Motohiko; Tsutsumi, Hirofumi; Iwazaki, Shigeru; Totsuka, Osamu; Matsumoto, Koshi; Takeyoshi, Izumi; Morishita, Yasuo

doi:10.1006/jsre.2001.6296

Cited by 12 publications

(4 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Histidine-tryptophan-ketoglutarate solution is a low viscosity solution initially developed for cardiac transplantation that has now proved a cheaper and acceptable alternative to UW in multi-organ preservation and perfusion (10,38,39). Celsior, an extracellular-type, low-potassium, low-viscosity preservation solution that was developed to act not only as a storage medium, but also as the perfusion fluid during initial donor heart arrest (40), has now been shown to be effective in kidney (41), pancreas (42), and liver preservation (43,44). Polysol, a new modified derivative of UW with a high sodium/low potassium composition, polyethylene glycol instead of hydroxyethyl starch and over 60 additives has recently proved effective in both machine perfusion of non-heartbeating donor livers (45) and cold storage of steatotic livers (46).…”

Section: Static Cold Preservation -Currents Status and Limitationsmentioning

confidence: 99%

Organ reperfusion and preservation

Jamieson

Friend²

2008

Front Biosci

View full text Add to dashboard Cite

Organ transplantation is one of the medical success stories of the 20th century. Transplantation is, however, a victim of its own success with demand for organs far exceeding supply. The ischemia/reperfusion injury associated with organ transplantation is complex with interlinking cellular pathways and cascades. With increasing use of marginal organs and better understanding of the consequences of ischemia/reperfusion, enhanced organ preservation is required. Traditional static cold preservation cannot prevent ischemia/reperfusion injury, the low temperature itself is damaging and viability testing is limited. Donor preconditioning techniques to enhance organ preservation in advance of retrieval are starting to show convergence on several key pathways (HO-1 and cell apoptosis). Microdialysis and bioimpedence techniques may allow viability assessment during cold storage. Hypothermic machine perfusion has a role to play, particularly in preservation of kidneys from non-heart-beating donors although results of clinical trials are awaited. Normothermic preservation offers benefits over cold storage (at least experimentally) by avoiding damage induced by low temperature, minimising ischemia/reperfusion injury and allowing resuscitation of damaged organs. Normothermic preservation is likely to increase as the average quality of donor organs declines and clinical trials are needed. In the long term, normothermic preservation may be used, not just to resuscitate organs, but facilitate organ immunomodulation.

show abstract

Section: Static Cold Preservation -Currents Status and Limitationsmentioning

confidence: 99%

Organ reperfusion and preservation

Jamieson

Friend²

2008

Front Biosci

View full text Add to dashboard Cite

show abstract

“…Use of low viscosity cold flush solutions has led to lower vascular resistance and improved survival 36. Celsior solution, with lower viscosity and lower potassium, is associated with reduced vascular endothelial cell injury compared to UW solution 55…”

Section: Experimental Strategiesmentioning

confidence: 99%

Commentary: How do we learn how to think?

White

2009

Biochem Molecular Bio Educ

View full text Add to dashboard Cite

“…36 Celsior solution, with lower viscosity and lower potassium, is associated with reduced vascular endothelial cell injury compared to UW solution. 55 Addition of glucagon to UW solution has been shown to enhance the endogenous cyclic AMP signal (cyclic AMP maintains cell shape and barrier function and improves hepatic microcirculation), which improved function and decreased hepatocellular injury in an ex vivo isolated rat NHBD liver perfusion model. 56…”

Section: Strategies At Retrievalmentioning

confidence: 99%

Liver transplantation from non-heart-beating donors: Current status and future prospects

et al. 2004

View full text Add to dashboard Cite

Liver transplantation is the treatment of choice for many patients with acute and chronic liver failure, but its application is limited by a shortage of donor organs. Donor organ shortage is the principal cause of increasing waiting lists, and a number of patients die while awaiting transplantation. Non -heart-beating donor (NHBD) livers are a potential means of expanding the donor pool. This is not a new concept. Prior to the recognition of brainstem death, organs were retrieved from deceased donors only after cardiac arrest. Given the preservation techniques available at that time, this restricted the use of extrarenal organs for transplantation. In conclusion, after establishment of brain death criteria, deceased donor organs were almost exclusively from heart-beating donors (HBDs). Categories 1 and 2 are termed "uncontrolled" (UCNHBD), as there is no time to organize the process of organ donation and there is a brief window of opportunity for organ retrieval. These donors are often patients who present to the emergency department. After declaration of death, organ donation is considered. Permission from the family for organ donation is usually sought after cardiac arrest. As the process of retrieval is only initiated after the declaration of death, these organs necessarily suffer a prolonged period of warm ischemia. Category 3 is termed "controlled" (CNHBD), as there is opportunity to obtain family consent and mobilize the retrieval team prior to withdrawal of support. For this reason, warm ischemia time can be reduced. Warm Ischemia TimeThe first international workshop in Maastricht, the Netherlands, held in 1995, recommended that warm ischemia should be counted from the moment of cardiac arrest until the start of hypothermic flush out. 2 There is a lack of uniform definition used in the published literature for liver transplantation. It has been variously defined as time between withdrawal of support and cold flushing of the organs, 3 time between hypotension (blood pressure Ͻ35 mm Hg) or low oxygen saturation (Ͻ25%) and flushing of the organs, 4 or time from extubation to aortic cross clamp. 5 A standardized definition and uniform application of warm ischemia time is needed for scientific comparison and interpretation of clinical results. The ProblemThe fundamental problem with NHBD organs is prolonged warm ischemia. Organ preservation and transplantation is associated with ischemia reperfusion injury. Cold preservation at 4°C slows metabolism and provides a milieu to limit the effect of ischemia. Although metabolism is slowed 1.5-to 2-fold for every 10°C drop in temperature, considerable metabolic activity still occurs at 1°C. 6 Adenosine triphosphate (ATP) is depleted and lack of oxygen converts aerobic metabolism to anaerobic metabolism, leading to accumulation of lactate and hypoxanthine, and development of intracellular acidosis. ATP is required to maintain the integrity of sodium / potassium pumps that

show abstract

Advantages of Celsior Solution in Graft Preservation from Non-Heart-Beating Donors in a Canine Liver Transplantation Model

Cited by 12 publications

References 27 publications

Organ reperfusion and preservation

Organ reperfusion and preservation

Commentary: How do we learn how to think?

Liver transplantation from non-heart-beating donors: Current status and future prospects

Contact Info

Product

Resources

About