HOPE for human liver grafts obtained from donors after cardiac death

Dutkowski, Philipp; Schlegel, Andrea; Oliveira, Michelle de; Müllhaupt, Beat; Neff, Fabienne; Clavien, Pierre‐Alain

doi:10.1016/j.jhep.2013.11.023

Cited by 290 publications

(310 citation statements)

References 40 publications

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“…In parallel, the Zurich group introduced into clinical practice hypothermic oxygenated machine perfusion. 5 The advantage of cold perfusion is its simplicity and resultant low risk of device failure-related graft loss. NMLP is technically more challenging, and therefore, carries a small risk of graft loss related to the device malfunction.…”

Section: Discussionmentioning

confidence: 99%

First human liver transplantation using a marginal allograft resuscitated by normothermic machine perfusion

et al. 2015

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Section: Discussionmentioning

confidence: 99%

First human liver transplantation using a marginal allograft resuscitated by normothermic machine perfusion

et al. 2015

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“…During end-ischemic MP and ex situ reperfusion, the perfusion fluid was oxygenated with 100% O 2 , and the PO 2 was 60 to 80 kPa (450-600 mm Hg), as described previously. 8,11,15,19 …”

Section: Scs End-ischemic Mp and Ex Situ Reperfusionmentioning

confidence: 99%

“…5,6 Although recent data from animal models and (discarded) human donor livers have provided promising results suggesting that endischemic MP has relevant protective effects on the bile ducts of donation after cardiac death (DCD) liver grafts, the most optimal perfusion temperature during end-ischemic MP has not been investigated. [7][8][9][10][11][12][13][14][15][16][17] The aim of this study was, therefore, to assess the optimal perfusion temperature during end-ischemic oxygenated MP for protection of the large bile ducts against I/R injury in a DCD rat liver model.…”

mentioning

confidence: 99%

End‐ischemic machine perfusion reduces bile duct injury in donation after circulatory death rat donor livers independent of the machine perfusion temperature

Westerkamp

Mahboub²,

Meyer

et al. 2015

Liver Transpl

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A short period of oxygenated machine perfusion (MP) after static cold storage (SCS) may reduce biliary injury in donation after cardiac death (DCD) donor livers. However, the ideal perfusion temperature for protection of the bile ducts is unknown. In this study, the optimal perfusion temperature for protection of the bile ducts was assessed. DCD rat livers were preserved by SCS for 6 hours. Thereafter, 1 hour of oxygenated MP was performed using either hypothermic machine perfusion, subnormothermic machine perfusion, or with controlled oxygenated rewarming (COR) conditions. Subsequently, graft and bile duct viability were assessed during 2 hours of normothermic ex situ reperfusion. In the MP study groups, lower levels of transaminases, lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances were measured compared to SCS. In parallel, mitochondrial oxygen consumption and adenosine triphosphate (ATP) production were significantly higher in the MP groups. Biomarkers of biliary function, including bile production, biliary bicarbonate concentration, and pH, were significantly higher in the MP groups, whereas biomarkers of biliary epithelial injury (biliary gamma-glutamyltransferase [GGT] and LDH), were significantly lower in MP preserved livers. Histological analysis revealed less injury of large bile duct epithelium in the MP groups compared to SCS. In conclusion, compared to SCS, end-ischemic oxygenated MP of DCD livers provides better preservation of biliary epithelial function and morphology, independent of the temperature at which MP is performed. End-ischemic oxygenated MP could reduce biliary injury after DCD liver transplantation. Liver Transpl 21:1300-1311, 2015. V C 2015 AASLD.Received March 17, 2015; accepted June 8, 2015.Ischemic cholangiopathy, also known as nonanastomotic biliary strictures (NAS), is one of the most prevalent and troublesome complications after liver transplantation. During NAS formation, in particular, the large (extrahepatic) bile ducts become fibrotic and/or necrotic. Patients with NAS may suffer from recurrent jaundice and episodes of cholangitis, and retransplantation may be the only curative treatment. 1 The combination of ischemia and ischemia/ reperfusion (I/R) injury has been shown to be a major Additional supporting information may be found in the online version of this article.

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“…After death declaration, a rapid laparotomy followed by aortic cannulation is performed, with perfusion of cold organ-preservation solution and decompression of the venous system. At other centers, instead of aortic cannulation, femoral vessels are cannulated either premortem (14,15) or postmortem (7), with a double-balloon triple-lumen (DBTL) catheter (7,15). Once death is declared, a cold preservation solution is perfused (in situ cold perfusion [ISP]), and blood is discharged through the femoral vein cannula.…”

Section: Consentmentioning

confidence: 99%

“…Several countries have reported cDCDD outcomes: the Netherlands (3), the United Kingdom (4), Canada (5), the United States (6), Switzerland (7), and Australia (8). Only a few cDCDD centers, however, have reported the use of extracorporeal membrane oxygenation (ECMO) to improve future graft outcome, including National Taiwan University Hospital, Taiwan (9); the University of Michigan, Ann Arbor, Michigan (10); the Henry Ford Health System, Detroit, Michigan (11); Wake Forest University, WinstonSalem, North Carolina (2); and three centers (Cambridge, Birmingham, and Edinburgh) in the United Kingdom (12).…”

Section: Introductionmentioning

confidence: 99%

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

Ave¹,

Shaw

Bernat

2016

American Journal of Transplantation

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The use of donor extracorporeal membrane oxygenation (ECMO) to improve graft outcomes by some controlled donation after circulatory determination of death (cDCDD) programs raises ethical issues. We reviewed cDCDD protocols using ECMO and the relevant ethics literature to analyze these issues. It is not obvious that ECMO in cDCDD improves graft outcomes. In our opinion, ECMO implemented before death can interfere with end-of-life care and damage bodily integrity. By restoring systemic circulation, ECMO risks invalidating the preceding declaration of death if brain and cardiac perfusion is not adequately excluded because of malfunction or misplacement of the supradiaphragmatic aortic occlusion balloon. The use of ECMO is not compatible with the acronym DCDD because circulation is restored after the determination of death. Because of these deficiencies, we concluded that other techniques are preferable, such as rapid recovery or in situ cold infusion. If ECMO is performed, it requires a specific informed consent and transparency.Abbreviations: cDCDD, controlled donation after circulatory determination of death; DBDD, donation after brain determination of death; DBTL, doubleballoon triple-lumen; DCDD, donation after circulatory determination of death; DDR, dead donor rule;

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HOPE for human liver grafts obtained from donors after cardiac death

Cited by 290 publications

References 40 publications

First human liver transplantation using a marginal allograft resuscitated by normothermic machine perfusion

First human liver transplantation using a marginal allograft resuscitated by normothermic machine perfusion

End‐ischemic machine perfusion reduces bile duct injury in donation after circulatory death rat donor livers independent of the machine perfusion temperature

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

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