Liver transplantation without graft ischemia in humans

Abstract

BACKGROUND Ischemia-reperfusion injury is considered an inevitable event that compromises posttransplant outcomes. Numerous treatments have been proposed to reduce its impact. However, most of them have had limited success, as none of them can completely avoid graft ischemia. METHODS Ischemia-free liver transplantation (IFLT) comprises surgical techniques to enable continuous oxygenated blood supply to brain-dead donor livers during procurement, preservation and implantation using normothermic machine perfusion technology. In this nonrandomized study, 38 donor livers were transplanted using IFLT and were compared to 130 livers procured and transplanted using a conventional procedure (CLT). RESULTS One patient (2.6%) suffered early allograft dysfunction in the IFLT group, compared with 43.8% of patients in the CLT group (absolute risk difference, 41.2 percentage points; 95% confidence interval, −31.3, −51.1). The median (range) peak aspartate aminotransferase levels within the first week (336, 149-4112 vs. 1445, 149-25083 U/L, P<0.001), and the median (range) total bilirubin levels on day 7 (2.11, 0.68-12.47 vs. 5.11, 0.56-51.97 mg/dL, P<0.001) posttransplantation were much lower in the IFLT than in the CLT group. The IFLT recipients had less need for renal replacement therapy (2.6% vs. 16.9%, P=0.02), shorter median (range) intensive care unit stay (34, 12-235 vs. 43.5, 7-936 hours, P=0.003), and higher one-year recipient survival (97.4% vs. 84.6%, P=0.02) and graft survival (94.7% vs. 83.8%, P=0.04) rates than the CLT recipients. The extended criteria donor livers in IFLT yielded faster posttransplant recovery than the standard criteria donor livers in CLT. CONCLUSIONS IFLT provides a new approach to minimize ischemia-reperfusion injury and improve post-transplant outcomes.

Abrogation of graft ischemia‐reperfusion injury in ischemia‐free liver transplantation

“…Proteome analysis also showed that neutrophil‐mediated immunity was enhanced in CLT grafts compared to IFLT grafts. However, we did not find a significantly reduced incidence of allograft rejection in the IFLT group, 16 probably due to the use of powerful immunosuppressive drugs and the limited sample size. Rebecca et al reported that exposure of the liver to IRI may subsequently cause inflammatory responses in other organs, which might lead to multiorgan failure 39 .…”

“…The detailed clinical data are described in our recently published paper. 16 There was no significant difference in donor and recipient characteristics between the two groups. IFLT recipients had a lower incidence of early allograft dysfunction, and higher one‐year graft/patient rates than CLT recipients.…”

“…During the study period, 38 IFLT recipients and 130 CLT recipients were recruited. The detailed clinical data are described in our recently published paper 16 . There was no significant difference in donor and recipient characteristics between the two groups.…”

Occurrence Regionalization of Kiwifruit Brown Spot in Sichuan

“…Therefore, in highly suitable areas, the introduction of resistant varieties, such as Ruiyu and Jinyan, should be recommended. Additionally, the "technical regulations for comprehensive control of kiwifruit brown spot" [31] formulated by Sichuan Agricultural University should be adopted for the scientific and efficient control of the disease. Consistent with the research conclusion of Cui [32], the incidence and disease index were significantly negatively correlated with altitude; as the altitude increased, they decreased gradually.…”