Machine perfusion in organ transplantation

Raemdonck, Dirk Van; Neyrinck, Arne; Rega, Filip; Devos, Timothy; Pirenne, Jacques

doi:10.1097/mot.0b013e32835c494f

Cited by 89 publications

(16 citation statements)

References 92 publications

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“…Several preclinical studies reported the successful delivery of various pharmacological agents, including propofol, hydrogen sulfide, carbon monoxide, nitric oxide, defatting cocktails, and nanoparticles, with the aim to modulate the release of molecules, involved in the IRI-cascade or to provide anti-oxidative protection during machine perfusion [81][82][83][84][85][86][87]. Due to the fact that most of the therapeutic interventions were tested during NMP, only limited data are available with in vivo therapeutics in HMP/HOPE [82,85,86].…”

Section: Allograft Therapies Surgical Interventions and On-pump Drumentioning

confidence: 99%

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Czigány

Lurje

Schmelzle

et al. 2020

JCM

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Ischemia-reperfusion injury (IRI) constitutes a significant source of morbidity and mortality after orthotopic liver transplantation (OLT). The allograft is metabolically impaired during warm and cold ischemia and is further damaged by a paradox reperfusion injury after revascularization and reoxygenation. Short-term and long-term complications including post-reperfusion syndrome, delayed graft function, and immune activation have been associated with IRI. Due to the current critical organ shortage, extended criteria grafts are increasingly considered for transplantation, however, with an elevated risk to develop significant features of IRI. In recent years, ex vivo machine perfusion (MP) of the donor liver has witnessed significant advancements. Here, we describe the concept of hypothermic (oxygenated) machine perfusion (HMP/HOPE) approaches and highlight which allografts may benefit from this technology. This review also summarizes clinical applications and the main aspects of ongoing randomized controlled trials on hypothermic perfusion. The mechanistic aspects of IRI and hypothermic MP—which include tissue energy replenishment, optimization of mitochondrial function, and the reduction of oxidative and inflammatory damage following reperfusion—will be comprehensively discussed within the context of current preclinical and clinical evidence. Finally, we highlight novel trends and future perspectives in the field of hypothermic MP in the context of recent findings of basic and translational research.

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Section: Allograft Therapies Surgical Interventions and On-pump Drumentioning

confidence: 99%

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Czigány

Lurje

Schmelzle

et al. 2020

JCM

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“…The therapeutic application of MSCs has been studied in reducing the IRI after organ transplantation, although their mechanism of action is still unclear [41, 42]. Twelve hour NMP of DCD porcine lungs with intravascular delivery of MSCs has shown increased levels of vascular endothelial growth factor (VEGF) in lungs and reduced levels of interleukin-8 (IL-8), which is a pro-inflammatory cytokine associated with reperfusion injury [43].…”

Section: Machine Perfusion: a Platform For Organ Treatmentmentioning

confidence: 99%

Opportunities for Therapeutic Intervention During Machine Perfusion

Karimian

Yeh

2017

Curr Transpl Rep

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Purpose of review There is a vast discrepancy between the number of patients waiting for organ transplantation and the available donor organs. Ex vivo machine perfusion (MP) has emerged in an effort to expand the donor pool, by improving organ preservation, providing diagnostic information, and more recently, acting as a platform for organ improvement. This article reviews the current status of MP with a focus on its role in organ preconditioning and therapeutic interventions prior to transplantation. Recent findings MP has allowed longer organ preservation compared to conventional static cold storage and allowed the use of organs that might otherwise have been discarded. Moreover, experimental studies have investigated the role of MP in reducing ischemia reperfusion injury of lungs, kidneys and livers by applying mesenchymal stem cells (MSCs), anti-inflammatory agents, cytotopic anticoagulants, and defatting cocktails. Summary MP has opened a new era in the field of organ transplantation and tissue medication.

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“…Once organs are retrieved from the body, ex vivo treatment especially during machine perfusion becomes possible [6]. Perfusion under physiological conditions providing oxygen and other metabolic substrates facilitates organ function recovery.…”

Section: Ex Vivo Medical Treatmentmentioning

confidence: 99%

“…Extracorporeal membrane oxygenation can even be used in awake, nonintubated patients, bridging the time till they receive a donor organ, and it can also give the patients' own diseased organs time for partial or complete recovery [4,5]. Furthermore, different organ perfusion systems have been developed and implemented in clinical practice in order to maintain the viability of organs ex vivo [6]. …”

Section: Introductionmentioning

confidence: 99%

Ex vivo Approach to Treat Failing Organs: Expanding the Limits

Ciubotaru

Haverich

2014

Eur Surg Res

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Background: Advanced organ failure is often classified as an end-stage disease where the treatment options are limited only to transplantation. As an alternative, different attempts have been undertaken to improve the outcome of the treatment of failing organs by using targeted ex vivo approaches. This may solve the issue of organ shortage by treating the donor organs before transplantation and the number of patients requiring transplantation may also be reduced by applying extensive ex vivo treatment followed by autotransplantation. Methods: We performed a literature review of PubMed and included articles published between 1962 and 2013. The following keywords were used (and; or): ex vivo, therapy, surgery, organ perfusion and autotransplantation. This review includes specific methods and attempts related to ex vivo organ perfusion and preservation, temporary life support systems, surgical and other therapeutic approaches, and diagnostic methods applied ex vivo to an isolated organ. Results: For the practical clinical use of ex vivo therapies, we could identify three major directions: (1) ex vivo pretransplant organ reconditioning, (2) ex vivo surgery and (3) ex vivo medical treatment. Different attempts have been made worldwide in the above-mentioned areas focusing on ex vivo organ preservation and treatment. We summarize in the present review the developments in the field of ex vivo organ recovery and evaluate the possibilities of combining and applying different technologies such as organ perfusion and storage, ex vivo exact topographical diagnosis, ex vivo locoregional medical treatment and ex vivo surgical correction. Conclusion: Ex vivo therapies open new horizons in the treatment of end-stage organ pathologies.

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Machine perfusion in organ transplantation

Cited by 89 publications

References 92 publications

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

Opportunities for Therapeutic Intervention During Machine Perfusion

Ex vivo Approach to Treat Failing Organs: Expanding the Limits

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