Suitability of livers for transplantation when treated by normothermic machine perfusion

Allard, Marc‐Antoine; Benítez, Carlos Castro; Imai, Katsunori; Selten, Jasmijn W.; Lopez, Alexandre; Sebagh, Mylène; Lemoine, Antoinette; Cunha, Antonio Sa; Cherqui, Daniel; Castaing, Denis; Vibert, Éric; Adam, René

doi:10.1111/ctr.13256

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…Therefore, there may be a role for transferring high-risk organs to "expert" reconditioning centers where they can be assessed and treated and then used or discarded. 105 The use of these techniques may expand the donor pool and result in a paradigm shift in what is considered possible in LT. Although all this is promising and exciting, there are currently no data to support this approach, and such should only be done under clinical investigational studies.…”

Section: Solutions and Prospectsmentioning

confidence: 99%

Changing Trends in Liver Transplantation: Challenges and Solutions

Ivanics¹,

Abreu²,

Martin³

2020

Transplantation

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Despite improvements in postliver transplant outcomes through refinements in perioperative management and surgical techniques, several changing trends in liver transplantation have presented challenges. Mortality on the waitlist remains high. In the United States, Europe, and the United Kingdom, there is an increasing need for liver transplantation, primarily as a result of increased incidence of nonalcoholic steatohepatitis-related cirrhosis and cancer indications. Meanwhile, donor suitability has decreased, as donors are often older and have more comorbidities. Despite a mismatch between organ need and availability, many organs are discarded. Notwithstanding this, many solutions have been developed to overcome these challenges. Innovative techniques in allograft preservation, viability assessment, and reconditioning have allowed the use of suboptimal organs with adequate results. Refinements in surgical procedures, including live donor liver transplantations, have increased the organ pool and are decreasing the time and mortality on the waitlist. Despite many challenges, a similar number of solutions and prospects are on the horizon. This review seeks to explore the changing trends and challenges in liver transplantation and highlight possible solutions and future directions.

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Section: Solutions and Prospectsmentioning

confidence: 99%

Changing Trends in Liver Transplantation: Challenges and Solutions

Ivanics¹,

Abreu²,

Martin³

2020

Transplantation

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“…New strategies to protect these fragile grafts from IRI are being developed, such as NMP, to evaluate their functions in real-time before transplantation, or defatting strategies, that have been described as potential tools to augment the donor pool. The problem is that it requires technical knowledge which increases the final cost of the procedure [5,38,39]; however, every single organ is submitted to a period of static cold storage (SCS) and preservation solution (PS) additives seem to overcome most of the obstacles seen in NMP or defatting.…”

Section: Discussionmentioning

confidence: 99%

A Novel Oxygen Carrier (M101) Attenuates Ischemia-Reperfusion Injuries during Static Cold Storage in Steatotic Livers

Asong-Fontem

Panisello‐Roselló

Lopez

et al. 2021

IJMS

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The combined impact of an increasing demand for liver transplantation and a growing incidence of nonalcoholic liver disease has provided the impetus for the development of innovative strategies to preserve steatotic livers. A natural oxygen carrier, HEMO2life®, which contains M101 that is extracted from a marine invertebrate, has been used for static cold storage (SCS) and has shown superior results in organ preservation. A total of 36 livers were procured from obese Zucker rats and randomly divided into three groups, i.e., control, SCS-24H and SCS-24H + M101 (M101 at 1 g/L), mimicking the gold standard of organ preservation. Ex situ machine perfusion for 2 h was used to evaluate the quality of the livers. Perfusates were sampled for functional assessment, biochemical analysis and subsequent biopsies were performed for assessment of ischemia-reperfusion markers. Transaminases, GDH and lactate levels at the end of reperfusion were significantly lower in the group preserved with M101 (p < 0.05). Protection from reactive oxygen species (low MDA and higher production of NO2-NO3) and less inflammation (HMGB1) were also observed in this group (p < 0.05). Bcl-1 and caspase-3 were higher in the SCS-24H group (p < 0.05) and presented more histological damage than those preserved with HEMO2life®. These data demonstrate, for the first time, that the addition of HEMO2life® to the preservation solution significantly protects steatotic livers during SCS by decreasing reperfusion injury and improving graft function.

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“…In fact, the safety and feasibility of ex-situ machine preservation have already been demonstrated. First clinical trials suggested reduced morbidity and mortality in recipients of high risk organs that were pretreated with extracorporeal machine perfusion devices [115][116][117] . Just recently, He et al [118] from Guangzhou transplant center presented the first case of "ischemia-free transplantation" of a severely steatotic graft by using normothermic machine perfusion without stopping blood supply, already initiated during donor liver harvesting.…”

Section: Improving Cancer-specific Outcome By Mitigating I/r Injurymentioning

confidence: 99%

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

Kornberg¹,

Schernhammer²

2018

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How to cite this article: Kornberg A, Schernhammer M. Liver transplantation for hepatocellular carcinoma -non-cancer factors and implications for improving outcome beyond standard tumor criteria. Hepatoma Res 2018;4:60. http://dx. AbstractLiver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer (HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which are current worldwide standards for patient selection, several biological tumor factors have been identified to affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits. Improving the immunological state and condition for appropriate defense against circulating cancer cell attack may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding the HCC LT selection criteria.

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Suitability of livers for transplantation when treated by normothermic machine perfusion

Abstract: Our results suggest that some discarded grafts might have been salvaged for transplantation. Further studies utilizing NMP with subsequent transplantation would validate this strategy.

Cited by 10 publications

References 29 publications

Changing Trends in Liver Transplantation: Challenges and Solutions

Changing Trends in Liver Transplantation: Challenges and Solutions

A Novel Oxygen Carrier (M101) Attenuates Ischemia-Reperfusion Injuries during Static Cold Storage in Steatotic Livers

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

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