Sequential hypothermic and normothermic perfusion preservation and transplantation of expanded criteria donor livers

Liu, Qiang; Prete, Luca Del; Ali, Khaled; Grady, Patrick; Bilancini, Mary; Etterling, John; D’Amico, Giuseppe; Uso, Teresa Diago; Hashimoto, Koji; Aucejo, Federico; Fujiki, Masato; Eghtesad, Bijan; Sasaki, Kazunari; Kwon, Choon Hyuck David; Chaudhry, Sulemon; Doi, Junshi; Pita, Alejandro; New, Brandon; Bennett, Ana E.; Cywiński, Jacek B.; Miller, Charles M.; Quintini, Cristiano

doi:10.1016/j.surg.2022.07.035

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Laing et al [118], based on a study in the UK, showed that 71% of organs originally unsuitable for transplantation could be transplanted using this method with 100% 90-day recipient/liver survival. Liu et al [119], on the other hand, investigated the efficacy of liver storage with hypothermic oxygenated perfusion (HOP) and normothermic machine perfusion techniques. They concluded that the use of HOP-NMP was safe and provided potential benefits in preserving the function of grafts harvested from expanded criteria donors.…”

Section: Perfusion Methods Considerationsmentioning

confidence: 99%

Modification of Preservative Fluids with Antioxidants in Terms of Their Efficacy in Liver Protection before Transplantation

Ostróżka-Cieślik

2024

IJMS

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Transplantation is currently the only effective treatment for patients with end-stage liver failure. In recent years, many advanced studies have been conducted to improve the efficiency of organ preservation techniques. Modifying the composition of the preservation fluids currently used may improve graft function and increase the likelihood of transplantation success. The modified fluid is expected to extend the period of safe liver storage in the peri-transplantation period and to increase the pool of organs for transplantation with livers from marginal donors. This paper provides a literature review of the effects of antioxidants on the efficacy of liver preservation fluids. Medline (PubMed), Scopus, and Cochrane Library databases were searched using a combination of MeSH terms: “liver preservation”, “transplantation”, “preservation solution”, “antioxidant”, “cold storage”, “mechanical perfusion”, “oxidative stress”, “ischemia-reperfusion injury”. Studies published up to December 2023 were included in the analysis, with a focus on publications from the last 30 years. A total of 45 studies met the inclusion criteria. The chemical compounds analyzed showed mostly bioprotective effects on hepatocytes, including but not limited to multifactorial antioxidant and free radical protective effects. It should be noted that most of the information cited is from reports of studies conducted in animal models, most of them in rodents.

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Section: Perfusion Methods Considerationsmentioning

confidence: 99%

Modification of Preservative Fluids with Antioxidants in Terms of Their Efficacy in Liver Protection before Transplantation

Ostróżka-Cieślik

2024

IJMS

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“…Observational studies from their group have demonstrated good outcomes with this approach despite being conducted in a group of extended criteria DCD donors (median DRI = 2.84) [56,57], as well as provided a set of criteria for viability testing [57,58]. Other studies from the US have also supported such an approach [59], though we are currently awaiting data from randomized trials.…”

Section: What We Know Nowmentioning

confidence: 99%

Machine perfusion in liver transplantation: recent advances and coming challenges

Wehrle,

Jiao,

Sun

et al. 2024

Current Opinion in Organ Transplantation

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Purpose of review Machine perfusion has been adopted into clinical practice in Europe since the mid-2010s and, more recently, in the United States (US) following approval of normothermic machine perfusion (NMP). We aim to review recent advances, provide discussion of potential future directions, and summarize challenges currently facing the field. Recent findings Both NMP and hypothermic-oxygenated perfusion (HOPE) improve overall outcomes after liver transplantation versus traditional static cold storage (SCS) and offer improved logistical flexibility. HOPE offers additional protection to the biliary system stemming from its’ protection of mitochondria and lessening of ischemia-reperfusion injury. Normothermic regional perfusion (NRP) is touted to offer similar protective effects on the biliary system, though this has not been studied prospectively. The most critical question remaining is the optimal use cases for each of the three techniques (NMP, HOPE, and NRP), particularly as HOPE and NRP become more available in the US. There are additional questions regarding the most effective criteria for viability assessment and the true economic impact of these techniques. Finally, with each technique purported to allow well tolerated use of riskier grafts, there is an urgent need to define terminology for graft risk, as baseline population differences make comparison of current data challenging. Summary Machine perfusion is now widely available in all western countries and has become an essential tool in liver transplantation. Identification of the ideal technique for each graft, optimization of viability assessment, cost-effectiveness analyses, and proper definition of graft risk are the next steps to maximizing the utility of these powerful tools.

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“…[42,44,45] The value of combined preservation strategies, such as NRP, followed by SCS and HOPE or HOPE with controlled rewarming and NMP, is currently explored. [46,47] WHAT IS THE POTENTIAL MARKET?…”

Section: Introductionmentioning

confidence: 99%

Obstacles to implement machine perfusion technology in routine clinical practice of transplantation: Why are we not there yet?

et al. 2023

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Machine perfusion of solid human organs is an old technique, and the basic principles were presented as early as 1855 by Claude Barnard. More than 50 years ago, the first perfusion system was used in clinical kidney transplantation. Despite the well-known benefits of dynamic organ preservation and significant medical and technical development in the last decades, perfusion devices are still not in routine use. This article describes the various challenges to implement this technology in practice, critically analyzing the role of all involved stakeholders, including clinicians, hospitals, regulatory, and industry, on the background of regional differences worldwide. The clinical need for this technology is discussed first, followed by the current status of research and the impact of costs and regulations.Considering the need for strong collaborations between clinical users, regulatory bodies, and industry, integrated road maps and pathways required to achieve a wider implementation are presented. The role of research development, clear regulatory pathways, and the need for more

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Sequential hypothermic and normothermic perfusion preservation and transplantation of expanded criteria donor livers

Cited by 10 publications

References 17 publications

Modification of Preservative Fluids with Antioxidants in Terms of Their Efficacy in Liver Protection before Transplantation

Modification of Preservative Fluids with Antioxidants in Terms of Their Efficacy in Liver Protection before Transplantation

Machine perfusion in liver transplantation: recent advances and coming challenges

Obstacles to implement machine perfusion technology in routine clinical practice of transplantation: Why are we not there yet?

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