Maschinenperfusion zur Konditionierung der Leber und Niere vor Transplantation

Becker, Felix; Pascher, Andreas; Brockmann, J. G.

doi:10.1007/s00104-020-01227-2

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Objective and reliable techniques in kidney graft viability assessment prior to transplantation are not established yet. Dynamic kidney preservation offers the opportunity to assess potential markers that may portray information on organ viability and quality [ 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

Weberskirch

Katou

Reuter

et al. 2022

JCM

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Kidney allografts are subjected to ischemia reperfusion injury during the process of transplantation. Hypothermic machine perfusion (HMP) of deceased donor kidneys from organ procurement until transplantation is associated with a superior outcome when compared to static cold storage (SCS). Nevertheless, cold ischemia time (CIT) remains an independent risk factor for delayed graft function (DGF) in HMP-preserved kidney allografts as well. We performed a retrospective single-center study including all adult recipients who underwent deceased donor kidney-only transplantation at our center between January 2019 and December 2020. Beside the clinicopathological donor and recipient data, flow and resistance data during HMP were assessed. Short- and long-term kidney allograft outcome after end-ischemic HMP and SCS were analyzed and compared. Organ preservation consisted of either SCS (n = 88) or HMP (n = 45). There were no differences in recipient demographics and donor details between groups. CIT was significantly longer in the HMP group (16.5 [8.5–28.5] vs. 11.3 [5.4–24.1], p < 0.0001). The incidence of DGF as well as serum creatinine at discharge and at 1 year post transplant were comparable between groups. Duration of SCS prior to HMP was comparable among grafts with and without DGF. Flow rate and organ resistance at the start of HMP were significantly worse in DGF-kidney grafts (arterial flow 22.50 [18.00–48.00] vs. 51.83 [25.50–92.67] ml/min, p = 0.0256; organ resistance 123.33 [57.67–165.50] vs. 51.33 [28.17–111.50] mmHg/mL/min, p = 0.0050). Recipients with DGF had significantly worse creatinine levels at discharge (2.54 [1.08–7.64] vs. 1.67 [0.90–6.56], p < 0.0001) and at 1 year post transplant (1.80 [1.09–7.95] vs. 1.59 [0.87–7.40], p = 0.0105). In conclusion, baseline HMP parameters could be applied as a predictive tool for initial graft function, which in turn determines long-term outcome.

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Section: Introductionmentioning

confidence: 99%

Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

Weberskirch

Katou

Reuter

et al. 2022

JCM

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“…This is especially relevant, as we are confronted with a severe donor shortage, forcing us to commonly evaluate marginal grafts, which is reflected by the rather high DRI above 2 in our cohort. Notably, the impact of the routine implementation of normothermic machine perfusion (NMP) on the outcome of older grafts, and likewise marginal grafts, will be the future focus of the transplant community [20]. There is currently one randomized controlled trial that demonstrates reduced ischemia-reperfusion injury (IRI) in older liver grafts (donors ≥ 70 years) undergoing NMP [21].…”

Section: Discussionmentioning

confidence: 99%

How Old Is Old? An Age-Stratified Analysis of Elderly Liver Donors above 65

Houben

Bormann

Kneifel

et al. 2022

JCM

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In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65–69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65–69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65–69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65–69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65–70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.

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“…However, the available clinical data are limited, and DCD organs are excluded in the current multicenter clinical trial on HTK-N in kidney, liver and pancreas transplantation [64]. Parallel to the increased utilization of DCD organs is rise of machine perfusion in solid organ transplantation [5]. In this setting, HTK-N has been used in different settings including hypothermic machine perfusion of rodent liver grafts [38], pulsatile oxygenated hypothermic machine perfusion of porcine kidney grafts [50] as well as machine-controlled oxygenated rewarming of porcine kidney and liver grafts [67,68].…”

Section: Discussionmentioning

confidence: 99%

“…There is an eminent unmet need to develop strategies to overcome the continuously growing imbalance between demand and supply in transplant medicine, which could be attenuated by increasing the donor pool or prolonging the lifetime of transplanted organs. Among the various strategies aiming to remedy these problems are structural improvements (e.g., increasing the general awareness and willingness towards organ donation), logistical refinements (e.g., enhance timing of transplantation) as well as approaches of donor reconditioning, enhancement of post-transplant care and especially the use of machine perfusion [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

HTK-N: Modified Histidine-Tryptophan-Ketoglutarate Solution—A Promising New Tool in Solid Organ Preservation

Mohr

Brockmann

Becker

2020

IJMS

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To ameliorate ischemia-induced graft injury, optimal organ preservation remains a critical hallmark event in solid organ transplantation. Although numerous preservation solutions are in use, they still have functional limitations. Here, we present a concise review of a modified Histidine-Tryptophan-Ketoglutarate (HTK) solution, named HTK-N. Its composition differs from standard HTK solution, carrying larger antioxidative capacity and providing inherent toxicity as well as improved tolerance to cold aiming to attenuate cold storage injury in organ transplantation. The amino acids glycine, alanine and arginine were supplemented, N-acetyl-histidine partially replaced histidine, and aspartate and lactobionate substituted chloride. Several in vitro studies confirmed the superiority of HTK-N in comparison to HTK, being tested in vivo in animal models for liver, kidney, pancreas, small bowel, heart and lung transplantation to adjust ingredients for required conditions, as well as to determine its innocuousness, applicability and potential advantages. HTK-N solution has proven to be advantageous especially in the preservation of liver and heart grafts in vivo and in vitro. Thus, ongoing clinical trials and further studies in large animal models and consequently in humans are inevitable to show its ability minimizing ischemia-induced graft injury in the sequel of organ transplantation.

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Maschinenperfusion zur Konditionierung der Leber und Niere vor Transplantation

Cited by 5 publications

References 27 publications

Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

Dynamic Parameters of Hypothermic Machine Perfusion—An Image of Initial Graft Function in Adult Kidney Transplantation?

How Old Is Old? An Age-Stratified Analysis of Elderly Liver Donors above 65

HTK-N: Modified Histidine-Tryptophan-Ketoglutarate Solution—A Promising New Tool in Solid Organ Preservation

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