Extracorporeal membrane oxygenation for resuscitation of deceased cardiac donor livers for hepatocyte isolation

Noormohamed, Mohamed Saleem; Kanwar, Aditya; Ray, Christopher; Wright, Matthew C.; Cowie, David E.; Stamp, S; Talbot, David; Manas, Derek; White, Steven A.

doi:10.1016/j.jss.2013.03.026

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…[22][23][24][25] This indicated that an early reoxygenation under normothermic conditions might be beneficial to protect and prepare organs for the upcoming additional ischemic injury during subsequent cold ischemia and organ transport. 22,24,26 The principles of NRP are to introduce oxygen early, immediately after donor warm ischemia in all abdominal organs and to allow assessment of the viability of the perfused organs before the cold flush, procurement, and SCS. The first clinical experiences with NRP in 2002 demonstrated that NRP could be successfully used for uncontrolled DCD livers (Maastricht category II).…”

Section: Hypothermic Oxygenated Perfusion (Hope D-hope Hmp-o 2 )mentioning

confidence: 99%

Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation

De Goeij,

De Meijer,

Mergental

et al. 2023

Transplantation

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Dynamic organ preservation is a relatively old technique which has regained significant interest in the last decade. Machine perfusion (MP) techniques are applied in various fields of solid organ transplantation today. The first clinical series of ex situ MP in liver transplantation was presented in 2010. Since then, the number of research and clinical applications has substantially increased. Despite the notable beneficial effect on organ quality and recipient outcome, MP is still not routinely used in liver transplantation. Based on the enormous need to better preserve organs and the subsequent demand to continuously innovate and develop perfusion equipment further, this technology is also beneficial to test and deliver future therapeutic strategies to livers before implantation. This article summarizes the various challenges observed during the current shift from static to dynamic liver preservation in the clinical setting. The different organ perfusion strategies are discussed first, together with ongoing clinical trials and future study design. The current status of research and the impact of costs and regulations is highlighted next. Factors contributing to costs and other required resources for a worldwide successful implementation and reimbursement are presented third. The impact of research on cost-utility and effectivity to guide the tailored decision-making regarding the optimal perfusion strategy is discussed next. Finally, this article provides potential solutions to the challenging field of innovation in healthcare considering the various social and economic factors and the role of clinical, regulatory, and financial stakeholders worldwide.

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Section: Hypothermic Oxygenated Perfusion (Hope D-hope Hmp-o 2 )mentioning

confidence: 99%

Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation

De Goeij,

De Meijer,

Mergental

et al. 2023

Transplantation

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“…Fan and his colleagues have shown favourable outcomes in hepatocytes isolated from specimens of benign liver disease. 17 Expanded criteria donor: Due to various limitations in obtaining Surgical liver specimens, Research scholars and clinicians have always tried to alter the selection criteria. By expanding the donor pool, a greater number of livers are available but at the cost of inferior quality of hepatocytes.…”

Section: Donor Related Factorsmentioning

confidence: 99%

Recommended parameters for hepatocyte isolation-a review

et al. 2020

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<p>There is an increasing demand for primary human hepatocytes for toxico-pharmacological studies and for exploring their role in liver cell transplantation. During the whole process of isolation, culture and cryopreservation hepatocytes are subjected to various stress. All these factors will lead to the impairment in the metabolic capability of the hepatocytes post isolation. Hepatocyte isolation is an expensive and resource driven procedure. Thus, it is important to consider all the factors before we subject the specimen for isolation of cells. By considering the factors that influence hepatocyte isolation, hepatocytes of good quality can be obtained. With recommendations on the ideal parameters for isolation being made the researcher shall have a knowledge on what critical factors need to be taken care of during hepatocyte isolation. There will be an opportunity to modify critical factors if possible, during the procurement of specimen by working in tandem with the clinicians. The specimen which shall be deemed un fit when two or more factors have exceeded the critical limits can be rejected.</p>

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“…Recently, new trials perfused oxygenated blood to the organs during the agonal period to keep the organs healthy. 16 However, the latter approach showed a good potential for preventing organs from ischemia, but the ethical problem arose as the blood perfusion can cause stress on the heart that can accelerate cardiac death. 17 More recently, a unique dual chamber stent graft was described to separate the abdominal (i.e., organs) blood flow from cardiac flow 18,19 .…”

Section: Introductionmentioning

confidence: 99%

In vitro and In vivo assessment of a novel organ perfusion stent for successful flow separation in donation after cardiac death

et al. 2022

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Shortage of healthy donors’ organs has appeared as one of the main challenges for organ transplantation. This study focuses on the novel endovascular device development to increase the number of available organs from cardiac death donors. The primary objective of this study is the design validation of a newly developed stent graft for the abdominal organ perfusion with cardiac blood flow isolation. In this paper, the effectiveness of the device design has been validated via the assessment of the device performance both in vitro and in vivo. The radial force of stent structure was first numerically analyzed using finite element method, then was quantified experimentally. The blood perfusion parameters were investigated to demonstrate their effect on the blood delivered to the abdominal organs, maintaining the organs healthy for donation. In vitro flow leakage was measured using a 3-D printing-based silicone aortic model to evaluate the isolation between cardiac flow and perfusion flow with minimum values. Following the design validation process, a functional prototype stent graft has been successfully fabricated using optimized laser welding conditions and subsequent joining processes. In vivo porcine study results have demonstrated smooth delivery and successful placement of the device showing complete cardiac flow separation isolating abdominal regions only with the oxygenated blood flow.

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Extracorporeal membrane oxygenation for resuscitation of deceased cardiac donor livers for hepatocyte isolation

Cited by 8 publications

References 33 publications

Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation

Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation

Recommended parameters for hepatocyte isolation-a review

In vitro and In vivo assessment of a novel organ perfusion stent for successful flow separation in donation after cardiac death

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