Fibrinolytic Preflush Upon Liver Retrieval From Non???heart Beating Donors to Enhance Postpreservation Viability and Energetic Recovery Upon Reperfusion

Minor, Thomas; Hachenberg, Andreas; Tolba, René; Pauleit, Dirk; Akbar, S

doi:10.1097/00007890-200106270-00015

Cited by 59 publications

(42 citation statements)

References 18 publications

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“…Plasminogen activators have been tested in LT to prevent microthrombosis, improve microcirculation and oxygen supply [71] . Liver grafts from non-heartbeating donors (NHBD) are additionally affected by microvascular alterations, including erythrocyte aggregation and thrombi formation, which might hamper appropriate equilibration of the preservation solution to the graft microvasculature [71] .…”

Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

“…Liver grafts from non-heartbeating donors (NHBD) are additionally affected by microvascular alterations, including erythrocyte aggregation and thrombi formation, which might hamper appropriate equilibration of the preservation solution to the graft microvasculature [71] . Streptokinase was used in experimental models to observe post-preservation viability in NHBD.…”

Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

“…Streptokinase was used in experimental models to observe post-preservation viability in NHBD. Streptokinase preflush resulted in a relevant and significant improvement of structural integrity as well as functional and metabolic recovery [71,72] . ITBL have a multifactorial origin but I/R injury and microthrombosis are considered to be the most relevant [73] .…”

Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

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Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

Section: Perfusion With Fibrinolytic Drugsmentioning

confidence: 99%

See 1 more Smart Citation

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

View full text Add to dashboard Cite

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“…In addition, numerous animal studies have indicated a variety of substances that have yielded positive results, but these agents have not been applied successfully thus far in humans. Cytoprotective drugs, including fibrinolytic agents (streptokinase), 37 vasodilators (phentolamine, epoprostenol, dopamine), 35,38 antibiotics, hormones (glucagon, growth factors), 39 and antioxidants (superoxide dismutase, edaravone), 40,41 also have been added to the flush and/or preservation solution and appear to be necessary because the organs tend to develop vasospasm, thrombus formation in the microcirculation, and colonic bacterial contamination secondary to the translocation of organs during WIT. 42,43 Although it appears that scientists have made headway in addressing key issues associated with DCD liver transplant, these points have yet to be proven in long-term follow-up studies or applied to clinical practice.…”

Section: Pharmacologic Modulationmentioning

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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“…After tissue water had been evaporated during at least 5 days of freeze drying, the samples were weighed to determine total dry weight. Tissue content of high-energy phosphates was determined by standard enzymatic tests, as described previously [21].…”

Section: Tissue Preparation and Biochemical Analysismentioning

confidence: 99%

Kidney transplantation from non-heart-beating donors after oxygenated low-flow machine per fusion preservation with histidine-tryptophan-ketoglutarate solution

2004

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The aim of this study was to determine the potential benefit of aerobic machine preservation (MP) with non-colloidal histidine-tryptophan-ketoglutarate (HTK) solution compared with MP with Belzer machine perfusion solution (MPS) and standard cold storage, after marginal kidneys had been obtained from non-heart-beating donors. Cardiac arrest was electrically induced in anaesthetized German landrace pigs (20-25 kg bw). Their kidneys were harvested 40 min thereafter, flushed with HTK by gravity of 100 cm H20 via the renal artery and then stored in HTK for 18 h at 4°C. Other organs were subjected to oxygenated (p02 > 500 mmHg) hypothermic pulsatile low-flow machine perfusion with HTK or MP with Belzer MPS at P,,,=40 mmHg, yielding transrenal flow values of 0.2-0.3 ml/min per g with HTK and approximately twice that amount with Belzer MPS. A well-preserved vascular endothelium and intact tubular epithelium were documented by electron microscopy at the end of perfusion preservation in both solutions as well as after cold storage. Concentrations of ATP (in micromoles per gramme) in tissue homogenates at the end of perfusion preservation with HTK were 1.18f0.12 vs 0.16 i 0.02 (P < 0.05) after simple cold storage and 2.43 f 0.23 after perfusion with Belzer MPS, thus documenting a relevant effect of low-flow perfusion on tissue oxygenation. Viability of the grafts was followed for 1 week after heterotopic transplantation and bilateral nephrectomy in the recipient pigs. Machine perfusion with HTK significantly improved cortical microcirculation upon early reperfusion in vivo, as well as maximal serum levels of urea and creatinine, compared to recipients receiving cold-stored grafts. No differences could be found between MP with HTK or Belzer MPS. In conclusion, provision of oxygen during storage is possible by low-flow perfusion with HTK as with Belzer MPS and apparently improves graft viability after transplan tation.

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Fibrinolytic Preflush Upon Liver Retrieval From Non???heart Beating Donors to Enhance Postpreservation Viability and Energetic Recovery Upon Reperfusion

Cited by 59 publications

References 18 publications

Strategies to optimize the use of marginal donors in liver transplantation

Strategies to optimize the use of marginal donors in liver transplantation

Untitled

Kidney transplantation from non-heart-beating donors after oxygenated low-flow machine per fusion preservation with histidine-tryptophan-ketoglutarate solution

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