Artificial Circulation of the Liver: Machine Perfusion as a Preservation Method in Liver Transplantation

Vekemans, Katrien; Liu, Qiang; Pirenne, Jacques; Monbaliu, Diethard

doi:10.1002/ar.20662

Cited by 33 publications

(18 citation statements)

References 44 publications

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“…Perfusion systems are capable of significantly impacting the availability of transplantable organs by optimally supporting donor organs during storage, and recovering reversibly damaged tissues through perfusate-based treatment protocols [26], [27]. To facilitate the translation of perfusion technology to clinical use, comprehensive and dynamic analyses of organ function during perfusion are needed that identify parameters critical to organ stability and recovery.…”

Section: Discussionmentioning

confidence: 99%

Resuscitation of Ischemic Donor Livers with Normothermic Machine Perfusion: A Metabolic Flux Analysis of Treatment in Rats

et al. 2013

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Normothermic machine perfusion has previously been demonstrated to restore damaged warm ischemic livers to transplantable condition in animal models. However, the mechanisms of recovery are unclear, preventing rational optimization of perfusion systems and slowing clinical translation of machine perfusion. In this study, organ recovery time and major perfusate shortcomings were evaluated using a comprehensive metabolic analysis of organ function in perfusion prior to successful transplantation. Two groups, Fresh livers and livers subjected to 1 hr of warm ischemia (WI) received perfusion for a total preservation time of 6 hrs, followed by successful transplantation. 24 metabolic fluxes were directly measured and 38 stoichiometrically-related fluxes were estimated via a mass balance model of the major pathways of energy metabolism. This analysis revealed stable metabolism in Fresh livers throughout perfusion while identifying two distinct metabolic states in WI livers, separated at t = 2 hrs, coinciding with recovery of oxygen uptake rates to Fresh liver values. This finding strongly suggests successful organ resuscitation within 2 hrs of perfusion. Overall perfused livers regulated metabolism of perfusate substrates according to their metabolic needs, despite supraphysiological levels of some metabolites. This study establishes the first integrative metabolic basis for the dynamics of recovery during perfusion treatment of marginal livers. Our initial findings support enhanced oxygen delivery for both timely recovery and long-term sustenance. These results are expected to lead the optimization of the treatment protocols and perfusion media from a metabolic perspective, facilitating translation to clinical use.

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Section: Discussionmentioning

confidence: 99%

Resuscitation of Ischemic Donor Livers with Normothermic Machine Perfusion: A Metabolic Flux Analysis of Treatment in Rats

et al. 2013

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“…In addition, bile production was a good viability indicator, in addition to measurements associated with other liver functions (detoxification, metabolism, or synthesis). 63 Moreover, the ATP content and redox active iron status of the liver during hypothermic machine perfusion also could be used to assess liver viability, 64 and normothermic (37°C) machine perfusion is particularly amenable to test viability when the liver is in a normal metabolic state.…”

Section: Figure 2 Ex Vivo Normothermic Machine Perfusion Systemmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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There are increasing numbers of patients on liver transplant waiting lists, and there is a continuing organ shortage crisis. Therefore, more centers and organ procurement organizations are developing protocols for donation after cardiac death. However, the effect of donation after cardiac death allografts on overall patient survival remains controversial, with some centers reporting equivalent patient posttransplant survival but many others indicating increased rates of complications, retransplant, utilization of resources, and death. Several potential risk factors that predict graft loss and recipient complications have been identified. To improve patient outcomes and reduce dropouts, experimental strategies that target both donors and recipients at various phases of the transplant process have focused on attenuating ischemia-reperfusion injury and have achieved encouraging results. In the present article, our goal is to provide an overview of the current status of, and recent advances in, liver transplant from donation after cardiac death, to better understand the risks and potential benefits of donation after cardiac death liver transplant.

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“…These are reviewed well in several places. [40][41][42][43][44][45][46][47][48] Only human clinical trial Clinically, static hypothermic CS is the criterion standard preservation method for liver transplant. Since the late 1960s, when Brettschneider and associates 49 and Starzl and associates 50 trialed MP, there has been little use of MP for human livers.…”

Section: Heart-type Fatty Acid Binding Proteinmentioning

confidence: 99%

Advances in Machine Perfusion Graft Viability Assessment in Kidney, Liver, Pancreas, Lung, and Heart Transplant

Balfoussia

Yerrakalva²,

Hamaoui³

et al. 2012

Exp Clin Transplant

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Artificial Circulation of the Liver: Machine Perfusion as a Preservation Method in Liver Transplantation

Cited by 33 publications

References 44 publications

Resuscitation of Ischemic Donor Livers with Normothermic Machine Perfusion: A Metabolic Flux Analysis of Treatment in Rats

Resuscitation of Ischemic Donor Livers with Normothermic Machine Perfusion: A Metabolic Flux Analysis of Treatment in Rats

Untitled

Advances in Machine Perfusion Graft Viability Assessment in Kidney, Liver, Pancreas, Lung, and Heart Transplant

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