Hypothermic oxygenated machine perfusion for extended criteria donor allografts: Preliminary experience with extended organ preservation times in the setting of organ reallocation

Abstract

Background: In times of critical organ shortage, poor organ pool utilization and increased use of extended-criteria donor (ECD) allografts remain a major problem. Hypothermic oxygenated machine perfusion (HOPE) has emerged as a promising and feasible strategy in ECD liver transplantation (LT). However, potential safety limits regarding the duration of perfusion are yet to be explored. Besides marginal allograft quality (steatosis), prolonged cold ischemia time remains the most important factor for a high number of liver allografts being declined for transplantation. Patients and Methods: Two ECD-allografts were each allocated to two recipients, who proved to be unsuitable to receive the assigned allograft upon arrival at the transplant center. The organs were reallocated by Eurotransplant and accepted by our center for two different backup patients. During that time, HOPE was commenced and continued until the recipient hepatectomy was completed. Postoperative allograft function was assessed by serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and International Normalized Ratio. Incidence of early allograft dysfunction (EAD), postoperative complications, and length of hospital stay were analyzed. Results: HOPE was applied for 4 h 35 min and 4 h 20 min, resulting in a total cold preservation time of 17 h 29 min and 15 h 20 min, respectively. Both recipients displayed decreasing serum transaminases and bilirubin levels postoperatively.

Prognostic and Predictive Molecular Markers in Cholangiocarcinoma

“…Patients with metastatic or inoperable disease are treated with systemic chemotherapy, albeit with dismal benefit [ 7 , 15 , 16 , 17 ]. Advancements in organ preservation and poor survival outcomes following surgical resection have promoted consideration of liver transplantation (LT) as a curative approach for patients suffering from pCCA and iCCA [ 18 , 19 ]. In fact, LT in patients adhering to the so-called Mayo clinic protocol, compromising neoadjuvant chemoradiation in patients with unresectable pCCA, size <3 cm and without extrahepatic or lymph node metastasis, offered promising results [ 20 ].…”

Prolonged dual hypothermic oxygenated machine preservation (DHOPE-PRO) in liver transplantation: study protocol for a stage 2, prospective, dual-arm, safety and feasibility clinical trial

“…8 9 In addition to organ resuscitation and protection against ischaemia-reperfusion injury, preclinical studies have investigated the potential to prolong preservation time using machine perfusion at hypothermic temperatures. [10][11][12][13][14] Organ allocation logistics, including prolonged cold ischaemia time, are important reasons to decline donor liver grafts. If machine perfusion can safely prolong preservation time, more livers could be accepted and liver transplantation may become a semielective procedure.…”

“…In addition to organ resuscitation and protection against ischaemia-reperfusion injury, preclinical studies have investigated the potential to prolong preservation time using machine perfusion at hypothermic temperatures 10–14. Organ allocation logistics, including prolonged cold ischaemia time, are important reasons to decline donor liver grafts.…”

“…To date, no clinical studies have investigated prolonged DHOPE (DHOPE-PRO) preservation. There are a few published cases in which hypothermic machine perfusion successfully extended preservation time with a maximum reported machine perfusion time of 8 hours 12 14 21 22…”

An Update on Usage of High-Risk Donors in Liver Transplantation

“…Compared to healthy allografts, extended criteria donor livers are more susceptible to ischemia- reperfusion injury and relevant impairment of allograft function upon prolonged cold ischemia time (CIT), and are, therefore, as-sociated with a higher risk of postoperative complications. Thus, simultaneously taking into consideration the waiting time is important [ 3 ].…”