Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Carlis, Riccardo De; Lauterio, Andrea; Centonze, Leonardo; Buscemi, Vincenzo; Schlegel, Andrea; Muiesan, Paolo; Carlis, Luciano De

doi:10.1007/s13304-022-01259-9

Cited by 19 publications

(23 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HMP is gaining increasing widespread acceptance in the preservation of marginal liver grafts [ 20 , 21 , 22 , 23 , 24 ]. Dual hypothermic oxygenated perfusion (D-HOPE) and HOPE have been proven effective in improving the post-transplant outcome of DCD and brain death (DBD) livers in two recent randomized controlled trials [ 25 , 26 ].…”

Section: The Evolution Of Hypothermic Machine Perfusionmentioning

confidence: 99%

“…Even when the perfusion is through the portal vein only, a certain fluid secretion through the biliary tree has been observed during HOPE, corresponding to perfusate mixed with molecules released from the hepatocytes [ 20 ]. However, this biliary fluid appears rather unphysiological due to the reduced secretory processes and has not been systematically assessed yet [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Therefore, some groups have explored the possibility of combining (D-)HOPE with subsequent controlled oxygenated rewarming and NMP for viability testing [ 15 , 48 ]…”

Section: Viability Parameters During Hmpmentioning

confidence: 99%

“…The Zurich group has recently found that FMN, determined by fluorescence spectroscopy in HOPE perfusate, correlated with early graft loss, cumulative complications, and hospital stay after liver transplant [ 29 , 60 ]. Based on these observations, if the FMN concentration climbs above 8800 AU at 30 min of HOPE or a sharp incline is seen, the authors recommend not to transplant the liver; while for an intermediate release (8800–5000 AU), they suggest allocating the liver to a low-risk recipient [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Some other groups have confirmed the correlation of FMN with posttransplant liver function, and external validation of this method is currently ongoing [ 20 , 60 ].…”

Section: Viability Parameters During Hmpmentioning

confidence: 99%

See 2 more Smart Citations

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

et al. 2022

View full text Add to dashboard Cite

With the increased use of extended-criteria donors, machine perfusion became a beneficial alternative to cold storage in preservation strategy for donor livers with the intent to expand donor pool. Both normothermic and hypothermic approach achieved good results in terms of mid- and long-term outcome in liver transplantation. Many markers and molecules have been proposed for the assessment of liver, but no definitive criteria for graft viability have been validated in large clinical trials and key parameters during perfusion still require optimization.In this review, we address the current literature of viability criteria during normothermic and hypothermic machine perfusion and discuss about future steps and evolution of these technologies.

show abstract

Section: The Evolution Of Hypothermic Machine Perfusionmentioning

confidence: 99%

Section: Viability Parameters During Hmpmentioning

confidence: 99%

Section: Viability Parameters During Hmpmentioning

confidence: 99%

See 1 more Smart Citation

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

et al. 2022

View full text Add to dashboard Cite

show abstract

“…DCD livers with extended donor risks are routinely transplanted in Italy, where a 20-min stand-off period contributes to a prolonged functional DWIT of 40–43 min [ 41 , 42 ]. Most Italian centers combine NRP with ex situ MP, mainly hypothermic techniques, and achieve excellent results with very low IC-rates and no liver-related graft loss ( Table 4 ) [ 35 , 41 , 42 , 130 ].…”

Section: The Impact Of Dynamic Organ Perfusion Strategiesmentioning

confidence: 99%

Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

Widmer

Eden

Carvalho

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

Based on the renaissance of dynamic preservation techniques, extended criteria donor (ECD) livers reclaimed a valuable eligibility in the transplantable organ pool. Being more vulnerable to ischemia, ECD livers carry an increased risk of early allograft dysfunction, primary non-function and biliary complications and, hence, unveiled the limitations of static cold storage (SCS). There is growing evidence that dynamic preservation techniques—dissimilar to SCS—mitigate reperfusion injury by reconditioning organs prior transplantation and therefore represent a useful platform to assess viability. Yet, a debate is ongoing about the advantages and disadvantages of different perfusion strategies and their best possible applications for specific categories of marginal livers, including organs from donors after circulatory death (DCD) and brain death (DBD) with extended criteria, split livers and steatotic grafts. This review critically discusses the current clinical spectrum of livers from ECD donors together with the various challenges and posttransplant outcomes in the context of standard cold storage preservation. Based on this, the potential role of machine perfusion techniques is highlighted next. Finally, future perspectives focusing on how to achieve higher utilization rates of the available donor pool are highlighted.

show abstract

“…In the light of a shortage of donor liver organs, the use of extended criteria donors (ECD) continues to rise. This poses a risk of increased rates of early allograft dysfunction (EAD), primary non-function (PNF) and biliary complications ( 1 – 10 ). Compared to standard criteria donor grafts, ECD livers are more susceptible towards ischemia-reperfusion injury (IRI).…”

Section: Introductionmentioning

confidence: 99%

Hyperspectral Imaging as a Tool for Viability Assessment During Normothermic Machine Perfusion of Human Livers: A Proof of Concept Pilot Study

Fodor¹,

Lanser²,

Hofmann³

et al. 2022

Transpl Int

View full text Add to dashboard Cite

Normothermic machine perfusion (NMP) allows for ex vivo viability and functional assessment prior to liver transplantation (LT). Hyperspectral imaging represents a suitable, non-invasive method to evaluate tissue morphology and organ perfusion during NMP. Liver allografts were subjected to NMP prior to LT. Serial image acquisition of oxygen saturation levels (StO2), organ hemoglobin (THI), near-infrared perfusion (NIR) and tissue water indices (TWI) through hyperspectral imaging was performed during static cold storage, at 1h, 6h, 12h and at the end of NMP. The readouts were correlated with perfusate parameters at equivalent time points. Twenty-one deceased donor livers were included in the study. Seven (33.0%) were discarded due to poor organ function during NMP. StO2 (p < 0.001), THI (p < 0.001) and NIR (p = 0.002) significantly augmented, from static cold storage (pre-NMP) to NMP end, while TWI dropped (p = 0.005) during the observational period. At 12–24h, a significantly higher hemoglobin concentration (THI) in the superficial tissue layers was seen in discarded, compared to transplanted livers (p = 0.036). Lactate values at 12h NMP correlated negatively with NIR perfusion index between 12 and 24h NMP and with the delta NIR perfusion index between 1 and 24h (rs = −0.883, p = 0.008 for both). Furthermore, NIR and TWI correlated with lactate clearance and pH. This study provides first evidence of feasibility of hyperspectral imaging as a potentially helpful contact-free organ viability assessment tool during liver NMP.

show abstract

Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Cited by 19 publications

References 31 publications

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

Viability Criteria during Liver Ex-Situ Normothermic and Hypothermic Perfusion

Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

Hyperspectral Imaging as a Tool for Viability Assessment During Normothermic Machine Perfusion of Human Livers: A Proof of Concept Pilot Study

Contact Info

Product

Resources

About