Impact of immunoadsorption on xenogeneic extracorporeal pig liver perfusion: assessment of organ function during autologous reperfusion

Abstract

The shortage of liver grafts has resulted in an intensive search for alternative strategies of liver support in acute liver failure. Extracorporeal perfusion of pig livers (ECLP) is not a new concept, but recent improvements in cardiopulmonary bypass technology and new knowledge about xenogeneic immunologic mechanisms have made it a potential therapeutic modality. In previous suboptimal experimental and clinical models, no statements about the beneficial effect of long-lasting periods of ECLP were made. The aim of this study was to evaluate the capacity of pig liver for metabolic regeneration after xenogeneic ECLP under largely physiologic conditions. To delay hyperacute rejection (HAR), we utilized immunoadsorption (IA) of naturally preformed xenogeneic antibodies (XNAbs). This led to a stable xenogeneic ECLP for 45 min. However, IA was not able to prevent completely organ damage or loss of function resulting from insufficient autologous reperfusion. The inability to regenerate during autologous reperfusion provides a new measure of the function of a xenogeneic perfused pig liver. In addition, our results implicate that patients with fulminant liver failure will benefit from short perfusions with several fresh organs rather than from long perfusion with a single pig liver.

Impact of Ig-Therasorb® Immunoapheresis on Stability of Xenogeneic Ex Vivo Porcine Liver Perfusion – Value of Aminotransferases and Flow Rates for the Assessment of Metabolic Graft Viability

“…They are able to bind all four subclasses of IgG antibodies as well as IgM and IgA antibodies. By enzyme-linked immunosorbent assay (ELISA) and nephelometry we could measure a reduction of IgG, IgM and IgA of 92%, 75% and 78% respectively, comparable with results already published (7,8).…”

Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: Evidence-based analysis of treatment outcome and associated factors

“…[13,14]. Besides, we discovered that the SL therapy may possibly reduce the increasing trend towards abnormal ASAT in patients with other underlying diseases.…”

“…[13,14]. These patients were treated consecutively with SL once a day for 8 days; the period of follow-up was 6 months.…”

Literature update 1999, part 3

“…Pre‐clinical studies were performed to assess the impact of immunoadsorption on extra‐corporeal pig liver perfusion [8]. There were also pre‐clinical studies using pig‐to‐primate heart transplantation [9], with one report showing better survival when the pig donor expressed both CD59 and human DAF transgenes [10].…”