Transplantation of a beating heart: A first in man

Yin, Shuo; Rong, Jian; Chen, Yinghua; Cao, Lu; Liu, Yunqi; Mo, Shaoyan; Li, Hanzhao; Nan, Jiang; Shi, Han; Wang, Tielong; Shi, Yongxu; Zhu, Yanling; Xiong, Wei; Chen, Yili; Xu, Guixing; Chen, Xiaoxiang; Chen, Xiaojun; Yin, Meizhen; Gong, Fengqiu; Huang, Wenqi; Dong, Yugang; Nashan, Björn; Stefan, Tullius G.; Guo, Zhiyong; He, Xiaoshun

doi:10.1016/j.lanwpc.2022.100449

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…Consistent with our previous studies, 7 - 9 the PV and HA perfusion flow kept stable during NMP and the perfusate lactate levels dropped rapidly to within normal range. Besides, the levels of perfusate AST, ALT, TBIL, and LDH levels stayed stable during ex situ NMP.…”

Section: Discussionsupporting

confidence: 91%

“…Then the liver grafts were procured and perfused using a temperature and pressure-controlled machine perfusion device (Liver Assist, Organ Assist, Groningen, The Netherlands), using a welldeveloped protocol. [7][8][9] During ex situ NMP, donor grafts were perfused with a target HA pressure of 50-60 mm Hg and PV pressure of 5-12 mm Hg. The temperature in perfusate was sustained between 36°C and 38°C.…”

Section: Iflt Procedures and Nmpmentioning

confidence: 99%

“…IFLT was performed as previously described. [7][8][9] Briefly, the donor livers were procured, preserved, and implanted with continuous blood supply. Perfusate components and additives were listed as follows: crossmatched leucocytedepleted washed red cells (~1.2 L), succinylated gelatinor (0.8 L), 5% sodium bicarbonate (150 mL), compound amino acid injection (150 mL), 10% calcium gluconate (30 mL), multitrace elements injection (10 mL), 25% magnesium sulfate (3 mL), imipenem and cilastatin sodium (1 g), metronidazole (0.5 g), methylprednisolone (0.5 g), and heparin (37 500 U).…”

Section: Iflt Procedures and Nmpmentioning

confidence: 99%

“…The concept has been practiced in liver, kidney, and heart transplantation. [7][8][9] Although it is claimed that ex situ NMP can provide a physiological condition for the liver, it is largely unknown concerning the different metabolism activities of the donor livers between the in situ and ex situ MP-preserved conditions.…”

Section: Introductionmentioning

confidence: 99%

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Metabolomics Differences of the Donor Livers Between In Situ and Ex Situ Conditions During Ischemia-free Liver Transplantation

et al. 2023

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Background. Ischemia-free liver transplantation (IFLT) has been innovated to avoid graft ischemia during organ procurement, preservation, and implantation. However, the metabolism activity of the donor livers between in the in situ and ex situ normothermic machine perfusion (NMP) conditions, and between standard criteria donor and extend criteria donor remains unknown. Methods. During IFLT, plasma samples were collected both at the portal vein and hepatic vein of the donor livers in situ during procurement and ex situ during NMP. An ultra-high performance liquid chromatography-mass spectrometry was conducted to investigate the common and distinct intraliver metabolite exchange. Results. Profound cysteine and methionine metabolism, and aminoacyl-tRNA biosynthesis were found in both in situ and ex situ conditions. However, obvious D-arginine and D-ornithine metabolism, arginine and proline metabolism were only found in the in situ condition. The suppressed activities of the urea cycle pathway during ex situ condition were confirmed in an RNA expression level. In addition, compared with extend criteria donor group, standard criteria donor group had more active intraliver metabolite exchange in metabonomics level. Furthermore, we found that the relative concentration of p-cresol, allocystathionine, L-prolyl-L-proline in the ex situ group was strongly correlated with peak alanine aminotransferase and aspartate aminotransferase at postoperative days 1–7. Conclusions. In the current study, we show the common and distinct metabolism activities during IFLT. These findings might provide insights on how to modify the design of NMP device, improve the perfusate components, and redefine the criteria of graft viability.

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Section: Discussionsupporting

confidence: 91%

Section: Iflt Procedures and Nmpmentioning

confidence: 99%

Section: Iflt Procedures and Nmpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metabolomics Differences of the Donor Livers Between In Situ and Ex Situ Conditions During Ischemia-free Liver Transplantation

et al. 2023

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“…Among all allografts, the heart is the most vulnerable to IRI. By combining adapted surgical techniques and NMP, the first ischemia-free beating heart transplantation (IFBHT) in human was performed by our group in 2021 [20]. Throughout the procedure, the sinusal rhythm, adequate ventricular contraction, oxygen consumption and lactate clearance, all indicated a good heart function of the donor heart.…”

Section: Ischemia-free Organ Transplantation Is Feasible In Liver Kid...mentioning

confidence: 99%

Ischemia-free organ transplantation − a review

Guo

Luo

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewOrgan transplantation is one of the miracles in medicine in the 20th century. However, in the current practice, all the donor organs suffer from ischemia/reperfusion injury (IRI), which compromise transplant outcomes and limits organ availability. Continuous efforts have been made in organ machine perfusion to ameliorate IRI. In 2017, ischemia-free organ transplantation (IFOT) was first proposed with the aim of complete avoidance of IRI in organ transplantation. The purpose of this review is to highlight the latest progresses in IFOT. Recent findingsThe feasibility of IFOT has been validated in liver, kidney, and heart transplantation. The results of the first nonrandomized controlled study demonstrate that ischemia-free liver transplantation (IFLT) may improve transplant outcomes and increase organ availability. Furthermore, laboratory results, including the absence of the characteristic pathological changes, gene transcription and metabolic reprogramming, as well as sterile inflammation activation in IFLT grafts, suggest the virtual avoidance of graft IRI in IFLT. SummaryIFOT might change the current practice by abrogating graft IRI. IFOT also provides a unique model to investigate the interaction between allograft IRI and rejection. The next steps will be to simplify the technique, make long-distance transportation possible and evaluate cost-effectiveness.

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