Extracorporeal Liver Perfusion System for Successful Hepatic Support Pending Liver Regeneration or Liver Transplantation: A Preclinical Controlled Trial

Abouna, G. M.; Ganguly, Pallab K.; Hamdy, Hossam; Jabur, Sabah S.; Tweed, W. A.; Costa, Giovani

doi:10.1097/00007890-199906270-00012

Cited by 42 publications

(14 citation statements)

References 16 publications

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“…65,66 The use of isolated perfusion to predict survival of steatotic livers before transplantation would merely require establishing parameters that correlate with survival. These may include hemodynamic parameters, 67 as well as markers of synthetic function 68 and liver injury 69 assessed by sampling perfusate.…”

Section: Potential For Novel Preservation Methods and Amelioration Ofmentioning

confidence: 99%

Hepatic steatosis and its relationship to transplantation

Imber

Peter

Handa

et al. 2002

Liver Transplantation

150

108

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Section: Potential For Novel Preservation Methods and Amelioration Ofmentioning

confidence: 99%

Hepatic steatosis and its relationship to transplantation

Imber

Peter

Handa

et al. 2002

Liver Transplantation

150

108

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“…An isolated porcine heart, liver or kidney that is perfused ex vivo with human or primate blood, has been used to study discordant xenograft HAR [81,82]. These models allow both the correlation of organ failure with the rejection process and the easy identification of rejection end points via frequent perfusate sampling or biopsy of the perfused xenograft [83].…”

Section: Ex Vivo Perfusion Modelsmentioning

confidence: 99%

Animal models in xenotransplantation

Zhang¹,

Bédard²,

Luo³

et al. 2000

Expert Opinion on Investigational Drugs

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The severe shortage of donor organs has provided a strong impetus to push the investigation into the use of animal organs for humans. Xenotransplantation will not only benefit patients, but also represents a unique and potentially profitable business opportunity. However, there are many barriers to successful clinical xenotransplantation, including immunological barriers, physiological incompatibility, zoonosis and ethical concerns. This overview will focus on currently available animal models used in attempts to break through the immunological barriers to xenotransplantation. There are many advantages to using small animal, namely rodent, models in xenotransplantation research. For example, the use of the mouse model allows the use of knockout mice and careful dissection of rejection mechanisms at the molecular level. The following models can be used to study hyperacute rejection (HAR): guinea-pig-to-rat, mouse-to-rabbit, guinea-pig-to-mouse, rat-to-presensitised mouse and rat-to-alpha-Gal knockout mouse. The hamster-to-rat, mouse-to-rat and rat-to-mouse models are commonly used to study acute vascular rejection. Large animal models are complex and expensive, but they are more relevant to clinical xenotransplantation. Based on experiments using transgenic pig-to-primate models, HAR can be overcome. However, acute vascular rejection remains a major barrier at the present time. A pig cartilage-to-monkey model has been developed to study chronic rejection. Other novel models such as pig venous segment-to-monkey model and rat-to-primate model may represent viable options to study immunological barriers following xenotransplantation. Like many other medical breakthroughs, animal research will continue to make enormous contributions towards the eventual success of xenotransplantation.

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“…19,20 Several authors as well as our group have proposed suitable circuits for ex vivo liver perfusion. 6,9,14,21 Besides the dual or sole portal vein ex vivo liver perfusion, one of the major problems was the level of the ex vivo liver blood flow during the perfusion. To maintain an appropriate liver perfusion, the required blood flow is approximately 0.8 to 1 ml/min -1 per g -1 of liver.…”

Section: Discussionmentioning

confidence: 99%

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Lhuillier

Pouyet²,

Mechet³

et al. 2006

ASAIO Journal

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Performing an ex vivo liver perfusion as a transient liver support requires perfusing the liver with a flow of 1 ml/min per kg of liver, which could reach 25% of the cardiac output when a human liver is used. This high flow could be detrimental in patients with acute liver failure. Therefore, in an ischemic-induced liver failure pig model, we developed a circuit allowing low flows going out of and into the systemic circulation, whereas the flow going through the ex vivo liver is maintained at a high value. This was obtained by uncoupling the ex vivo circuit from the systemic circulation. Ex vivo liver perfusion was performed in a closed circuit with a flow averaging 1 ml/min per kg of ex vivo liver (700 to 800 ml/min, according to the weight of the livers we used). It was linked to the systemic circulation with input and output flows equal to that used during hemodialysis (200 ml/min). Compared with previously reported direct circuits, this perfusion system was well tolerated from a circulatory point of view. After the induction of ischemic liver failure, the ex vivo liver perfusion led to an increase in urea, branched amino acids to aromatic amino acid ratio, and fractional clearance of indocyanine green and galactose and to a decrease in ammonia and lactic acid. This system allowed the ex vivo liver to keep its clearing properties despite a low extracorporeal flow. It represents an extracorporeal circuit that could be used in place of the direct extracorporeal high-flow liver perfusion.

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Extracorporeal Liver Perfusion System for Successful Hepatic Support Pending Liver Regeneration or Liver Transplantation: A Preclinical Controlled Trial

Cited by 42 publications

References 16 publications

Hepatic steatosis and its relationship to transplantation

Hepatic steatosis and its relationship to transplantation

Animal models in xenotransplantation

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

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