Hypothermic perfusion preservation: The future of organ preservation revisited?

Extracorporeal perfusion of isolated organs of large animals – Bridging the gap between in vitro and in vivo studies

“…Using lower flow rates may better preserve microcirculation (Cypel et al, 2008) and prevent edema formation (Constantinescu et al, 2011). Other authors however describe weight gain and increased organ resistance due to uncharacteristic sheer forces and viscosity of cold solutions as drawbacks of hypothermic pressure-driven flow rate perfusions (Fuller and Lee, 2007). This weight gain however might be the result of several components working together rather than being solely attributed to the hypothermic perfusion itself.…”

“…This weight gain however might be the result of several components working together rather than being solely attributed to the hypothermic perfusion itself. Low temperatures may also lead to reduced antioxidant defenses and subsequently to production of free radicals and toxic concentrations of superoxides within tissues (Fuller and Lee, 2007). In contrast, it is known from extracorporeal perfusion during CPB that hypothermia eases inflammation in the brain (Schmitt et al, 2007).…”

“…Carbogen may be chosen when the buffer capacity of commonly used cell-free perfusion solutions depends on the presence of CO 2 (Mancina et al, 2015) or when using solutions without oxygen carriers, as these require a higher O 2 content than in room air to meet the tissues' oxygen demand. Pure oxygen is rarely used in perfusion experiments as unphysiologically high oxygen tension may lead to the production of free radicals (Fuller and Lee, 2007) and a lack of buffer capacity of CO 2 may cause a pH drop. Carbogen of varying relative CO 2 concentrations has been used (2.5% (Grosse-Siestrup et al, 2002b) to 7% (Hardwick and Linzell, 1960)).…”

“…Hypothermic perfusions are adopted for isolated organ and limb perfusions with the aim to promote organ preservation and facilitate reimplantation (Smith et al, 1985;Domingo-Pech et al, 1991;Guarrera et al, 2004;Constantinescu et al, 2011;Müller et al, 2013). Hypothermia slows cellular metabolism and oxygen consumption, allowing lower flow rates and perfusates without specific oxygen carriers to meet metabolic requirements (Fuller and Lee, 2007). Using lower flow rates may better preserve microcirculation (Cypel et al, 2008) and prevent edema formation (Constantinescu et al, 2011).…”

“…In CPB experiments, pulsatile perfusion using hydraulically driven dual-chamber physiological pulsatile pumps enabled better and necrosis, their protection leads to a reduction in cellular damage and therefore better preservation and (re)transplantation outcomes (Fuller and Lee, 2007).…”