Anaphylaxis to Machine Perfusion Substrate at Reperfusion: A Cautionary Tale

Does machine perfusion enhance graft contamination risk? Fungal graft arteritis following normothermic machine perfusion of neonatal en‐bloc kidney: A case study

“…Unlike SCS‐CPF, the contaminated cold perfusate of Hypothermic machine perfusion (HMP) and warm perfusate of NMP continuously circulate through the donor organ every minute in a pressure‐controlled pulsatile fashion from low flow (ml/min) at 30–40 mmHg in HMP to a high flow (ml/min) at 70–80 mmHg in NMP, resulting in an increased chance of machine‐perfused organ receiving an infection with every pass of contaminated perfusion fluid through the organ. As endothelium is the first point of contact with the pressure‐pumped perfusate, high‐risk pathogens causing graft arteritis or clinical syndrome of post‐NMP sepsis will likely be more common in machine‐perfused organs than SCS, as seen in the index case and reported recently in both HMP kidney and liver and NMP livers 7,8,14,15 . Although, the international practice guidelines regarding therapy for HMP and NMP contaminant microbiomes are lacking.…”

“…As endothelium is the first point of contact with the pressure-pumped perfusate, high-risk pathogens causing graft arteritis or clinical syndrome of post-NMP sepsis will likely be more common in machine-perfused organs than SCS, as seen in the index case and reported recently in both HMP kidney and liver and NMP livers. 7,8,14,15 Although, the international practice guidelines regarding therapy for HMP and NMP contaminant microbiomes are lacking. The near future holds promise for therapeutic intervention, repair, and reconditioning of damaged organs on NMP that will eventually require an extended duration of preservation with an increased risk of graft contamination.…”