Machine perfusion in liver transplantation

Tingle, Samuel J; Dobbins, Joseph J; Thompson, Emily R; Figueiredo, Rodrigo S; Mahendran, Balaji; Pandanaboyana, Sanjay; Wilson, Colin

doi:10.1002/14651858.cd014685.pub2

Cited by 4 publications

(5 citation statements)

References 105 publications

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“…155 A Cochrane review by Tingle et al affirmed improved graft survival, reduced severe adverse events, and minimized ischemic biliary complications in DCD donors. 154 These findings, supported by high to moderate evidence, align with three other meta-analyses. 151 152 153 Maspero et al even found that organ perfusion techniques were associated with a lower incidence of acute cellular rejection, particularly in DCD grafts with HOPE.…”

Section: Perfusion Techniquessupporting

confidence: 78%

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Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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Liver transplantation (LT) is a highly effective treatment for carefully selected patients with hepatocellular carcinoma (HCC). In this review, we explored the development of LT selection criteria and organ allocation policies, comparing original data to underscore their historical progression into the intricate task of quantitatively estimating pre- and post-LT survivals. We emphasized the role of biomarkers such as serum AFP, DCP, circulating tumor cells, and circulating tumor DNA in predicting patient outcomes. Additionally, we examined the transplant-associated survival benefits and the difficulties in accurately calculating these benefits. We also reviewed recent advancements in targeted therapy and checkpoint inhibitors for advanced, inoperable HCC and projected their integration into liver transplantation for HCC. We further discussed the growing use of living donor liver transplants in the United States and compared its outcomes with those of deceased donor liver transplants. Furthermore, we examined the progress in machine perfusion techniques, which have shown potential in improving patient outcomes and enlarging the donor pool. These advancements present opportunities to enhance LT patient survivals, refine selection criteria, establish new priority metrics, develop innovative bridging and downstaging strategies, and formulate redesigned LT strategies for HCC treatments.

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Section: Perfusion Techniquessupporting

confidence: 78%

“…151 However, other meta-analyses reached different conclusions due to the substantial variability in the studies using normothermic perfusion techniques. 152 153 154…”

Section: Perfusion Techniquesmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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“…The score was created using a multivariate logistic regression model that considered post-transplant HCC recurrence (no/yes) as the dependent variable. Eighteen confounding factors that have clinical significance were chosen to serve as covariates for both DFS and OS: patient sex [20]; age [21]; HCV [22]; diabetes mellitus at transplant [23]; CKD at transplant [24]; MELD score [25]; donor sex [26]; donor age [27]; cerebrovascular accident (CVA) as donor cause of death [28]; use of machine perfusion (MP) [29]; CIT [30]; pre-transplant tumor stage according to Milan criteria [31]; pre-transplant alpha-fetoprotein (AFP) [32]; efficacy of pre-transplant downstaging and defined as downstaging from beyond to within Milan criteria [33]; tumor stage at histology according to Milan criteria [31][32][33]; G3-G4 tumor grading [34]; presence of microvascu-lar infiltration [34]; and mean TAC trough level within the first post-transplant month (≤10 ng/mL) [35].…”

Section: Statistical Analysesmentioning

confidence: 99%

Everolimus Mitigates the Risk of Hepatocellular Carcinoma Recurrence after Liver Transplantation

De Simone,

Precisi,

Lai

et al. 2024

Cancers

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To obtain long-term data on the use of everolimus in patients who underwent liver transplantation for hepatocellular carcinoma, we conducted a retrospective, single-center analysis of adult recipients transplanted between 2013 and 2021. Patients on everolimus-incorporating immunosuppression were matched with those on tacrolimus using an inverse probability of treatment weighting methodology. Two propensity-matched groups of patients were thus compared: 233 (45.6%) receiving everolimus versus 278 (54.4%) on tacrolimus. At a median (interquartile range) follow-up of 4.4 (3.8) years after transplantation, everolimus patients showed a reduced risk of recurrence versus tacrolimus (7.7% versus 16.9%; RR = 0.45; p = 0.002). At multivariable analysis, microvascular infiltration (HR = 1.22; p < 0.04) and a higher tumor grading (HR = 1.27; p < 0.04) were associated with higher recurrence rate while being within Milan criteria at transplant (HR = 0.56; p < 0.001), a successful pre-transplant downstaging (HR = 0.63; p = 0.01) and use of everolimus (HR = 0.46; p < 0.001) had a positive impact on the risk of post-transplant recurrence. EVR patients with earlier drug introduction (≤30 days; p < 0.001), longer treatment duration (p < 0.001), and higher drug exposure (≥5.9 ng/mL; p < 0.001) showed lower recurrence rates versus TAC. Based on our experience, everolimus provides a reduction in the relative risk of hepatocellular carcinoma recurrence, especially for advanced-stage patients and those with earlier drug administration, higher drug exposure, and longer time on treatment. These data advocate for early everolimus introduction after liver transplantation to reduce the attrition rate consequent to chronic immunosuppression.

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“…8,9 The implementation of NLMP as a clinical routine has helped to ease logistics and increase organ utilization. 6,10 Herein, we summarize our experience with the systematic application of prolonged normothermic perfusion and subsequent transplantation of split liver grafts.…”

Section: Introductionmentioning

confidence: 99%

Normothermic Liver Machine Perfusion and Successful Transplantation of Split Liver Grafts: From Proof of Concept to Clinical Implementation

Krendl,

Cardini,

Laimer

et al. 2024

Transplantation

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Background. Normothermic liver machine perfusion (NLMP) is advancing the field of liver transplantation (LT). Beyond improved preservation and organ assessment, NLMP helps to increase organ utilization. We herein address the feasibility and merit of NLMP in split liver transplantation (SLT) to postpone the transplantation of the second split graft to the following day. Methods. We analyzed the perfusion characteristics and outcomes of all consecutive adult recipients who underwent SLT following NLMP from February 1, 2018, to June 30, 2023. The primary endpoint was 90-d graft and patient survival. Secondary endpoints were posttransplant complications and 90-d morbidity. Results. Three right and 3 extended right SLT following NLMP have been performed. NLMP was uneventful in all cases. Perfusion characteristics differed according to graft volume. Mean perfusion time was 17:00 h (±05:13) and bile production ranged between 8 and 21 mL/h. All split grafts fulfilled predefined center viability criteria during NLMP and were transplanted on the following day. The 90-d graft and patient survival rate was 100%. Three patients (50%) required an early relaparotomy, and 2 patients (33.3%) developed biliary complications. The 90-d morbidity as recorded by the comprehensive complication index was 62.7 (±24.7). Conclusion. NLMP of split liver grafts is technically feasible and safe. Through prolongation of preservation time, NLMP allows to safely postpone transplantation of the second split liver graft to the next day.

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Machine perfusion in liver transplantation

Cited by 4 publications

References 105 publications

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Everolimus Mitigates the Risk of Hepatocellular Carcinoma Recurrence after Liver Transplantation

Normothermic Liver Machine Perfusion and Successful Transplantation of Split Liver Grafts: From Proof of Concept to Clinical Implementation

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