The New Horizon of Split‐Liver Transplantation: Ex Situ Liver Splitting During Hypothermic Oxygenated Machine Perfusion

Spada, Marco; Angelico, Roberta; Grimaldi, Chiara; Francalanci, Paola; Saffioti, Maria Cristina; Rigamonti, Andrea; Pariante, R.; Bianchi, Roberto; Dionisi‐Vici, Carlo; Candusso, M.; Maggiore, Giuseppe

doi:10.1002/lt.25843

Cited by 26 publications

(30 citation statements)

References 5 publications

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“…( 11 ) Combined with machine perfusion, this may abrogate the negative physiological consequences of prolonged ischemia time especially in ex situ ERLT. ( 20 ) Although information on splitting technique was not available in this study, the analysis revealed a CIT cut‐off of 10 hours, beyond which the outcomes of ERLT are suboptimal. This confirms that logistics and donor‐recipient matching are essential for optimal graft allocation and successful ERLT.…”

Section: Discussionmentioning

confidence: 81%

Outcome of Extended Right Lobe Liver Transplantations

et al. 2021

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Split‐liver transplantation offers a solution to the organ shortage problem. However, the outcomes of extended right lobe liver transplantation (ERLT) and whether it is a suitable alternative to full‐size liver transplantation (FSLT) remain controversial. We compared the outcomes of ERLT and FSLT in adult recipients of 43,409 first deceased donor liver transplantations using Cox regression. We also analyzed 612 ERLT and 1224 FSLT 1:2 matched cases to identify factors that affect ERLT outcome. The risk of graft loss was significantly higher following ERLT than following FSLT during the first posttransplantation year in the matched and unmatched collective (hazard ratio [HR], 1.39 and 1.27 and P = 0.01 and 0.006, respectively). Every additional hour of cold ischemia time (CIT) increased the risk of 1‐year graft loss by 10% in the ERLT group compared with only 3% in the FSLT group (P = 0.003 and <0.001, respectively). Importantly, the outcome of ERLT and FSLT did not differ significantly if the CIT was below 10 hours (HR, 0.71; P = 0.22). One‐year graft and patient survival were lower in high‐risk ERLT recipients with a Model for End‐Stage Liver Disease (MELD) score of ≥20 (HR, 1.88; P = 0.03 and HR, 2.03; P = 0.02). In the male recipient–male donor combination, ERLT recipients had a higher risk of 1‐year graft loss than FSLT recipients (HR, 2.44; P = 0.006). This was probably because of the significantly higher MELD score in ERLT recipients (P = 0.004). ERLT in adults is an adequate alternative to FSLT and offers an elegant solution to the problem of organ shortage as long as the cold storage is less than 10 hours and the recipient’s MELD score is <20.

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Section: Discussionmentioning

confidence: 81%

Outcome of Extended Right Lobe Liver Transplantations

et al. 2021

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“…This highlights the potential in the split technique, as we can hypothesize that both lobes will behave metabolically and physiologically in the same way (28). In essence, if each lobe has good function, we are therefore able to further increase the donor pool by utilizing what previously was one suboptimal liver allograft into two viable transplantable allografts (27,29,30).…”

Section: The Rationale Of Organ Preservation By Machine Perfusionmentioning

confidence: 91%

Organ Restoration With Normothermic Machine Perfusion and Immune Reaction

et al. 2020

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“…Split-liver transplantation can help increase the available donor pool but can create two extended-criteria grafts and increase the risk of transplant failure 1 , 2 . Hence, split-liver grafts may be considered marginal because of their small size 3 and the degree of incurred injury due to liver splitting 4 . Moreover, poor post-transplantation outcomes have been reported even with a warm ischemic time of 10 min 5 .…”

Section: Introductionmentioning

confidence: 99%

Beneficial effects of end-ischemic oxygenated machine perfusion preservation for split-liver transplantation in recovering graft function and reducing ischemia–reperfusion injury

Ishii

Matsuno

Gochi

et al. 2021

Sci Rep

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This study examined the efficacy of end-ischemic hypothermic oxygenated machine perfusion preservation (HOPE) using an originally developed machine perfusion system for split-liver transplantation. Porcine split-liver grafts were created via 75% liver resection after 10 min of warm ischemia. In Group 1, grafts were preserved by simple cold storage (CS) for 8 h (CS group; n = 4). In Group 2, grafts were preserved by simple CS for 6 h and end-ischemic HOPE for 2 h (HOPE group; n = 5). All grafts were evaluated using an isolated ex vivo reperfusion model with autologous blood for 2 h. Biochemical markers (aspartate aminotransferase and lactate dehydrogenase levels) were significantly better immediately after reperfusion in the HOPE group than in the CS group. Furthermore, the HOPE group had a better histological score. The levels of inflammatory cytokines (tumor necrosis factor-α, interferon-γ, interleukin-1β, and interleukin-10) were significantly lower after reperfusion in the HOPE group. Therefore, we concluded that end-ischemic HOPE for split-liver transplantation can aid in recovering the graft function and reducing ischemia–reperfusion injury. HOPE, using our originally developed machine perfusion system, is safe and can improve graft function while attenuating liver injury due to preservation.

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The New Horizon of Split‐Liver Transplantation: Ex Situ Liver Splitting During Hypothermic Oxygenated Machine Perfusion

Cited by 26 publications

References 5 publications

Outcome of Extended Right Lobe Liver Transplantations

Outcome of Extended Right Lobe Liver Transplantations

Organ Restoration With Normothermic Machine Perfusion and Immune Reaction

Beneficial effects of end-ischemic oxygenated machine perfusion preservation for split-liver transplantation in recovering graft function and reducing ischemia–reperfusion injury

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