Machine perfusion of the liver and bioengineering

Schlegel, Andrea; Mergental, Hynek; Fondevila, Constantino; Porte, Robert J.; Friend, Peter J.; Dutkowski, Philipp

doi:10.1016/j.jhep.2023.02.009

Cited by 16 publications

(5 citation statements)

References 135 publications

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“…Primary injury can occur at various stages during the transplantation procedure. An extended warm ischemia time in the donor, particularly when combined with additional cold storage, represents a key risk factor for the development of biliary strictures [ 44 , 45 , 46 ]. Following reperfusion, the damage is aggravated as accumulated oxygen-containing reactive species (ROS) and damage-associated molecular patterns (DAMPs) proceed to activate the immune system causing necrosis and apoptosis.…”

Section: Biliary Injurymentioning

confidence: 99%

Cholangiocyte Organoids: The New Frontier in Regenerative Medicine for the Study and Treatment of Cholangiopathies

Babboni,

Vacca,

Simonini

et al. 2024

JCM

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Cholangiopathies include a group of chronic progressive disorders, affecting the cholangiocytes, the epithelial cells that line the biliary tree, leading to liver parenchymal fibrosis and eventually end-stage liver disease necessitating transplantation. Experimental modeling of these multifactorial cholestatic diseases faces challenges due to the lack of adequate experimental in vitro and in vivo models. A novel approach employs three-dimensional organoid systems that offer several advantages for modeling disease and testing drug response in vitro. Organoids mimic intercellular communication, replicate the architecture of organs, and maintain the cell’s original phenotype. Cholangiocyte organoids provide an in vitro model to study the pathogenesis and pharmacotherapeutic treatment of cholangiopathies and show great promise for regenerative therapies. In particular, patient-derived organoids allow personalized medicine approaches and the study of individual disease characteristics. This review highlights the significance of cholangiocyte organoid models in advancing our understanding of cholangiopathies and driving advancements in regenerative medicine strategies.

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Section: Biliary Injurymentioning

confidence: 99%

Cholangiocyte Organoids: The New Frontier in Regenerative Medicine for the Study and Treatment of Cholangiopathies

Babboni,

Vacca,

Simonini

et al. 2024

JCM

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“…[62] Although there is still no exhaustive evidence in support of liver defatting via machine perfusion [63] with pharmacology treatments, [60] this alternative should be considered for further studies considering its potential. [64]…”

Section: Main Factors Contributing To Iri Steatosismentioning

confidence: 99%

“…Microsteatosis may be a risk factor for postoperative complications; however, it presents lower significance than macrosteatosis 62 . Although there is still no exhaustive evidence in support of liver defatting via machine perfusion 63 with pharmacology treatments, 60 this alternative should be considered for further studies considering its potential 64 …”

Section: Main Factors Contributing To Irimentioning

confidence: 99%

Liver ischemia-reperfusion injury: From trigger loading to shot firing

Felli,

Muttillo

et al. 2023

Liver Transplantation

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An ischemia-reperfusion injury (IRI) results from a prolonged ischemic insult followed by the restoration of blood perfusion, being a common cause of morbidity and mortality, especially in liver transplantation. At the maximum of the potential damage, IRI is characterized by 2 main phases. The first is the ischemic phase, where the hypoxia and vascular stasis induces cell damage and the accumulation of damage-associated molecular patterns and cytokines. The second is the reperfusion phase, where the local sterile inflammatory response driven by innate immunity leads to a massive cell death and impaired liver functionality. The ischemic time becomes crucial in patients with underlying pathophysiological conditions. It is possible to compare this process to a shooting gun, where the loading trigger is the ischemia period and the firing shot is the reperfusion phase. In this optic, this article aims at reviewing the main ischemic events following the phases of the surgical timeline, considering the consequent reperfusion damage.

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“…These include LTs using higher-risk liver allografts, such as those from donors infected with the hepatitis virus for recipients who have never had hepatitis [2][3][4][5][6]. Concurrently, changes in societal and medical landscapes have led surgeons to explore new types of LTs, such as LTs for recipients with COVID-19 infections and those involving machine perfusion for organ preservation [7][8][9][10][11][12][13][14][15]. Within this context, some centers have reported significant increases in their transplant volumes without compromising outcomes, despite the expanded utilization of marginal or higher-risk grafts and the substantial adoption of new practices [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The Spread Pattern of New Practice in Liver Transplantation in the United States

Akabane,

Imaoka,

Esquivel

et al. 2024

Clinical Transplantation

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BackgroundIntroducing new liver transplantation (LT) practices, like unconventional donor use, incurs higher costs, making evaluation of their prognostic justification crucial. This study reexamines the spread pattern of new LT practices and its prognosis across the United States.MethodsThe study investigated the spread pattern of new practices using the UNOS database (2014–2023). Practices included LT for hepatitis B/C (HBV/HCV) nonviremic recipients with viremic donors, LT for COVID‐19‐positive recipients, and LT using onsite machine perfusion (OMP). One year post‐LT patient and graft survival were also evaluated.ResultsLTs using HBV/HCV donors were common in the East, while LTs for COVID‐19 recipients and those using OMP started predominantly in California, Arizona, Texas, and the Northeast. K‐means cluster analysis identified three adoption groups: facilities with rapid, slow, and minimal adoption rates. Rapid adoption occurred mainly in high‐volume centers, followed by a gradual increase in middle‐volume centers, with little increase in low‐volume centers. The current spread patterns did not significantly affect patient survival. Specifically, for LTs with HCV donors or COVID‐19 recipients, patient and graft survivals in the rapid‐increasing group was comparable to others. In LTs involving OMP, the rapid‐ or slow‐increasing groups tended to have better patient survival (p = 0.05) and significantly improved graft survival rates (p = 0.02). Facilities adopting new practices often overlap across different practices.DiscussionOur analysis revealed three distinct adoption groups across all practices, correlating the adoption aggressiveness with LT volume in centers. Aggressive adoption of new practices did not compromise patient and graft survivals, supporting the current strategy. Understanding historical trends could predict the rise in future LT cases with new practices, aiding in resource distribution.

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Machine perfusion of the liver and bioengineering

Cited by 16 publications

References 135 publications

Cholangiocyte Organoids: The New Frontier in Regenerative Medicine for the Study and Treatment of Cholangiopathies

Cholangiocyte Organoids: The New Frontier in Regenerative Medicine for the Study and Treatment of Cholangiopathies

Liver ischemia-reperfusion injury: From trigger loading to shot firing

The Spread Pattern of New Practice in Liver Transplantation in the United States

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