Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Abstract

There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft's for transplantation, improve the outcomes, and decrease the mortality on the waiting list. Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6(2): 314320 Available from: URL:

A Comparative Study of Single and Dual Perfusion During End-ischemic Subnormothermic Liver Machine Preservation

“…Many different perfusion settings have been used in the constantly evolving field of machine liver preservation. 3 , 4 One of the debates has been on using a single (portal vein) or dual (portal vein and hepatic artery) approach during machine perfusion preservation. 11 , 27 Although SP adds simplicity, the effect of additional arterial perfusion has not been investigated.…”

Primary Nonfunction of the Liver Allograft

“…This may be severe enough to cause irreversible cell injury even before the procurement of organs. 73,74 The initial warm ischaemia compounds the subsequent cold ischemia, and DCD grafts do not tolerate the same duration of cold ischaemia as a comparable DBD donor. Both warm ischemic time and CIT are factors that can be modified to a certain degree.…”

The efficacy of HBOC‐201 in ex situ gradual rewarming kidney perfusion in a rat model

“…One of the challenges in organ transplant is improving the organ preservation method especially in the grafts with inferior quality such as donor after circulatory death (DCD) . Machine perfusion has been developed as an alternative preservation method to cold storage (CS) with promising results in organ quality improvement .…”

“…One of the challenges in organ transplant is improving the organ preservation method especially in the grafts with inferior quality such as donor after circulatory death (DCD). 1,2 Machine perfusion has been developed as an alternative preservation method to cold storage (CS) with promising results in organ quality improvement. [3][4][5] Different perfusion protocols have been studied by many groups and among the emerged perfusion protocols, normothermic machine perfusion has gained more attention as it provides the feasibility of assessing organ viability and function before transplant.…”