Extended preservation of non-heart-beating donor livers with normothermic machine perfusion

Peter, Shawn D. St.; Imber, Charles; López, I. Martínez; Hughes, David; Friend, Peter J.

doi:10.1046/j.1365-2168.2002.02052.x

Cited by 159 publications

(152 citation statements)

References 14 publications

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“…Given the complexity and financial burden of a large animal transplantation model, a simulation phase was used to explore our hypothesis, as done previously by other authors (9,10). Innate and adaptive immune responses subsequent to IRI are possible only if all cells are released from compartments such as the spleen, lymph nodes and bone marrow.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are important for several reasons. First, NMP is rapidly becoming the subject of preclinical and clinical research (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Second, different research groups have used various perfusion protocols but none have compared their efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Normothermic machine perfusion (NMP) is a preservation technology with potential to prevent both ischemic injury and the deleterious effect of cold temperatures by perfusing organs with a warm oxygenated perfusion solution. Numerous studies have demonstrated the advantage of NMP over CS in the preservation of DCD livers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), suggesting that NMP may greatly benefit the practice of liver transplantation. conducted using whole blood (WB) (9)(10)(11)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc., Denver, CO), Steen plus red blood cells (RBCs), or whole blood (WB). All livers were preserved for 10 h and reperfused to simulate transplantation for 24 h. During preservation, the NMP with Steen group presented the highest hepatocellular injury. At reperfusion, the CS group had the lowest bile production and the worst hepatocellular injury compared with all other groups, followed by NMP with Steen; the Steen plus RBC and WB groups presented the best functional and hepatocellular injury outcomes, with WB livers showing lower aspartate aminotransferase release and a trend toward better results for most parameters. Based on our results, a perfusate that contains an oxygen carrier is most effective in a model of NMP porcine DCD livers compared with Steen solution. Specifically, WB-perfused livers showed a trend toward better outcomes compared with Steen plus RBCs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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“…Other authors have also proposed the use of techniques of extracorporeal machine donor perfusion instead of cold storage, as it has been reported that NHBD grafts are more susceptible to cold ischemia that is preceded by warm ischemia in this type of donor. [25][26][27] We believe that progress in this field will be critical to expanding the utilization of UNHBDs.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n ϭ 1) for the UNHBD group and 0% for the BDD group (P ϭ 0.15). The rate of primary nonfunction was 10% (n ϭ 2) in UNHBD recipients and 2.5% (n ϭ 1) in BDD recipients (P ϭ 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P ϭ 0.012). After a mean follow-up of 330.4 Ϯ 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P ϭ 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P ϭ 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

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“…St Peter et al 12 used a pig model to discover that DCD livers undergoing normothermic machine perfusion recovered liver function significantly better than livers in cold storage. Livers were subjected to 1 hour of warm ischemia before preservation.…”

Section: Commentsmentioning

confidence: 99%

Infrahepatic cavocavostomy: Expanding the armamentarium for the liver transplant surgeon

Perkins

2009

Liver Transpl

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We describe our experience with a modification of the piggyback (PB) technique for orthotopic liver transplantation in which the donor infrahepatic vena cava is used as the venous outflow tract. From May 1997 to January 2006, a total of 109 cases using this technique were performed in 101 patients. Collected data included recipient demographics and diagnosis, warm ischemia time, use of venovenous bypass or temporary portacaval shunt and complications related to the venous outflow and graft, and patient survival. Data were compared with the patients undergoing standard PB technique during the same period. The reasons for using the technique were grouped according to whether there was a problem with the recipient hepatic veins or a concern about the length or diameter of the donor suprahepatic vena cava. These included the presence of a transjugular intrahepatic portosystemic shunt (eight cases), retransplantation (22 cases), thin-walled, friable hepatic veins (32 cases), Budd-Chiari syndrome (two cases), domino liver procurement (six cases), reduced or split liver grafts (five cases), and graft inferior vena cava to recipient hepatic veins size discrepancy (34 cases). There was no graft loss. The warm ischemia time was 39.65 minutes compared with 37 minutes in the standard PB group. The long-term graft and patient survival rates were similar in the two groups. Infrahepatic vena cavocavostomy is a useful variation of the standard PB technique.

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Extended preservation of non-heart-beating donor livers with normothermic machine perfusion

Abstract: Warm ischaemia for 1 h and simple cold storage (UW solution) for 24 h renders the liver non-viable. Oxygenated, sanguinous perfusion as a method of preservation recovers liver function to a viable level after 24 h of preservation.

Cited by 159 publications

References 14 publications

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Infrahepatic cavocavostomy: Expanding the armamentarium for the liver transplant surgeon

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