Background. Normothermic machine perfusion (NMP) bears the potential for significant prolongation of liver preservation before transplantation. Although safety and feasibility have been recently published, no data are available describing the significant challenges of establishing NMP programs outside clinical studies. We herein present our experience and propose a multidisciplinary approach for liver NMP in the clinical routine. Methods. In February 2018, liver NMP was introduced for routine use in marginal organs, logistic challenges, and complex recipients at our institution. In a multidisciplinary effort among transplant coordinators, perfusionists, transplant surgeons, anesthesia, nurses, blood bank as well as laboratory staff, a clinical routine was established and 34 NMP cases were performed without critical incidents or organ loss. Results. Nine livers were discarded due to poor organ quality and function observed during NMP. Twenty-five livers were successfully transplanted after preservation of up to 38 h. The extended criteria donors rate was 100% and 92% in discarded and transplanted livers, respectively. Nighttime procedures and parallel transplantations were eventually omitted. Graft and patient survival was 88% at 20 mo. No cholangiopathy was observed despite the use of extended criteria donor organs in 92% of cases. Conclusions. NMP in a multidisciplinary approach enables a safe prolongation of liver preservation and overnight organ care. A first field test of NMP indicates safety and benefit of this approach.

The ultrasound approach to the facet joints in the lumbar spine is feasible with minimal risks in a large majority of patients and results in a significant reduction of procedure duration and radiation dose.

Objective. We conducted this study to develop a sonographically guided approach to the spinal nerve of the lumbar spine and to assess its feasibility and accuracy by means of computed tomography (CT). Methods. Fifty sonographically guided approaches at 5 levels (L1-S1) were performed on 5 embalmed cadavers, which were positioned prone. The spinal nerves of the lumbar spine were shown under sonographic guidance. In 1 cadaver, the most lateral aspect of the roof of the intervertebral foramen was defined as a reference point. Its position was computed as a distance from the tip of the spinal process (A), the midline (B), and the intervertebral disk (C). Subsequently, axial transverse CT scans were made to verify these distances. In a second part of the experiment, a spinal needle was advanced under sonographic guidance to the spinal nerves for each lumbar spinal level on 1 embalmed cadaver. The exact placement of the needle tips was checked with the help of CT. Results. This technique for a sonographically guided approach to the periradicular area proved to be feasible and accurate. Sonography and CT provided the same mean measurements of 4.0, 2.5, and 1.4 cm for distances A, B, and C, respectively. The Pearson correlation coefficient was 0.99 (P < .001) between sonography and CT. In the experimental study, all 10 needle tips were placed periradicular to the spinal nerves. Conclusions. Sonographic guidance is a useful adjunct to increase the safety and efficacy of periradicular injections in the lumbar spine. Key words: feasibility; periradicular injection; sonography. Neurosurgery (K.G., A.A.O.) and Radiology (G.B., M.F.) and Institute of Anatomy and Histology (H.M.), Leopold-Franzens-University, Innsbruck, Austria; Department of Anesthesiology and Pain Care, Hospital of Vipiteno, Vipiteno, Italy (F.S.K., F.P.); and RTI International, Durham, North Carolina USA (R.S.) Received August 9, 2004, from the Clinics of