Successful extracorporeal porcine liver perfusion for 72 hr1

Butler, Andrew; Rees, Michael; Wight, D. G. D.; Casey, N.; Alexander, Graeme; White, David J.; Friend, Peter J.

doi:10.1097/00007890-200204270-00005

Cited by 182 publications

(166 citation statements)

References 28 publications

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“…Numerous studies have demonstrated the advantage of NMP over CS in the preservation of DCD livers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), suggesting that NMP may greatly benefit the practice of liver transplantation. conducted using whole blood (WB) (9)(10)(11)(19)(20)(21). The same group recently introduced NMP in human liver transplantation using blood and additives during perfusion (18).…”

Section: Introductionmentioning

confidence: 99%

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc., Denver, CO), Steen plus red blood cells (RBCs), or whole blood (WB). All livers were preserved for 10 h and reperfused to simulate transplantation for 24 h. During preservation, the NMP with Steen group presented the highest hepatocellular injury. At reperfusion, the CS group had the lowest bile production and the worst hepatocellular injury compared with all other groups, followed by NMP with Steen; the Steen plus RBC and WB groups presented the best functional and hepatocellular injury outcomes, with WB livers showing lower aspartate aminotransferase release and a trend toward better results for most parameters. Based on our results, a perfusate that contains an oxygen carrier is most effective in a model of NMP porcine DCD livers compared with Steen solution. Specifically, WB-perfused livers showed a trend toward better outcomes compared with Steen plus RBCs.

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Section: Introductionmentioning

confidence: 99%

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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“…Perfusate reservoirs may be gassed using glassware with a sintered glass filter (Tindal, 1957), with a bubble oxygenator, which bubbles (pure) oxygen through the blood reservoir (Smith et al, 1985), or by using a rotating disc oxygenator Cameron et al, 1972), whereby several parallel discs rotate within the reservoir containing unoxygenated blood and the gas exchange occurs at the disc-blood interface. More recently, the use of membrane or hollow fiber oxygenators (Butler et al, 2002;Müller et al, 2013) typically deployed during CPB surgery or life support (extracorporeal membrane oxygenation) has been reported in perfusion experiments. These systems generally follow the same concept as rotating disc oxygenators, as oxygen exchange occurs at a porous membrane.…”

Section: Perfusatementioning

confidence: 99%

“…Instead of autologous blood perfusions, several experiments have utilized homologous blood or blood components with no apparent negative effects (Hebb and Linzell, 1951;Cameron et al, 1972;Butler et al, 2002). While this may simplify the experimental set-up and potentially reduce inter-animal variability, it is plausible that incompatibility reactions can occur, thereby affecting outcome variables.…”

Section: Perfusatementioning

confidence: 99%

“…Glycolysis represents the main energy source for living tissue, ensures ATP production under anaerobic and aerobic conditions (Silbernagl and Despopoulos, 2012) and is consumed by specimens in perfusion experiments. Glucose is therefore an often used additive in blood based solutions (Butler et al, 2002;Patan et al, 2009) and part of the basic recipe of artificial fluids. Closed systems require a regular compensation for glucose loss.…”

Section: Cell Free Solutionsmentioning

confidence: 99%

“…Most commonly a standard combination of β-lactam antibiotics (usually penicillin (Hardwick et al, 1961;Riviere et al, 1989;Bristol et al, 1991)) and aminoglycosides (usually streptomycin (Hardwick et al, 1961) or gentamicin (Riviere et al, 1989;Bristol et al, 1991)) were chosen. The drugs were applied via the perfusate either constantly (Riviere et al, 1989;Domingo-Pech et al, 1991) or intermittently (Butler et al, 2002). However, many studies have been successful without the use of antibiotics.…”

Section: Oxygenmentioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal perfusion of isolated organs of large animals – Bridging the gap between in vitro and in vivo studies

Daniel¹

2018

ALTEX

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Impact of Portable Normothermic Blood-Based Machine Perfusion on Outcomes of Liver Transplant

Abouljoud²,

et al. 2022

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IMPORTANCE Ischemic cold storage (ICS) of livers for transplant is associated with serious posttransplant complications and underuse of liver allografts.OBJECTIVE To determine whether portable normothermic machine perfusion preservation of livers obtained from deceased donors using the Organ Care System (OCS) Liver ameliorates early allograft dysfunction (EAD) and ischemic biliary complications (IBCs). DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical trial (International Randomized Trial to Evaluate the Effectiveness of the Portable Organ Care System Liver for Preserving and Assessing Donor Livers for Transplantation) was conducted between November 2016 and October 2019 at 20 US liver transplant programs. The trial compared outcomes for 300 recipients of livers preserved using either OCS (n = 153) or ICS (n = 147). Participants were actively listed for liver transplant on the United Network of Organ Sharing national waiting list. INTERVENTIONS Transplants were performed for recipients randomly assigned to receive donor livers preserved by either conventional ICS or the OCS Liver initiated at the donor hospital. MAIN OUTCOMES AND MEASURESThe primary effectiveness end point was incidence of EAD. Secondary end points included OCS Liver ex vivo assessment capability of donor allografts, extent of reperfusion syndrome, incidence of IBC at 6 and 12 months, and overall recipient survival after transplant. The primary safety end point was the number of liver graft-related severe adverse events within 30 days after transplant. RESULTSOf 293 patients in the per-protocol population, the primary analysis population for effectiveness, 151 were in the OCS Liver group (mean [SD] age, 57.1 [10.3] years; 102 [67%] men), and 142 were in the ICS group (mean SD age, 58.6 [10.0] years; 100 [68%] men). The primary effectiveness end point was met by a significant decrease in EAD (27 of 150 [18%] vs 44 of 141 [31%]; P = .01). The OCS Liver preserved livers had significant reduction in histopathologic evidence of ischemia-reperfusion injury after reperfusion (eg, less moderate to severe lobular inflammation: 9 of 150 [6%] for OCS Liver vs 18 of 141 [13%] for ICS; P = .004). The OCS Liver resulted in significantly higher use of livers from donors after cardiac death (28 of 55 [51%] for the OCS Liver vs 13 of 51 [26%] for ICS; P = .007). The OCS Liver was also associated with significant reduction in incidence of IBC 6 months (1.3% vs 8.5%; P = .02) and 12 months (2.6% vs 9.9%; P = .02) after transplant.CONCLUSIONS AND RELEVANCE This multicenter randomized clinical trial provides the first indication, to our knowledge, that normothermic machine perfusion preservation of deceased donor livers reduces both posttransplant EAD and IBC. Use of the OCS Liver also resulted in increased use of livers from donors after cardiac death. Together these findings indicate that OCS Liver preservation is associated with superior posttransplant outcomes and increased donor liver use.

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Successful extracorporeal porcine liver perfusion for 72 hr1

Cited by 182 publications

References 28 publications

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Extracorporeal perfusion of isolated organs of large animals – Bridging the gap between in vitro and in vivo studies

Impact of Portable Normothermic Blood-Based Machine Perfusion on Outcomes of Liver Transplant

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