New Strategies and Concepts in Organ Preservation

Abstract

Organ transplantation is still affected by a notable degree of preservation-associated ischemia and reperfusion injury, which can seriously hamper early graft function. The increasing extension of the criteria for donor organ acceptance, especially for organs that have suffered from periods of warm ischemic injury prior to graft retrieval, results in even higher demands on preserving these ischemia-sensitive grafts. Growing attention is thus directed towards more dynamic preservation methods instead of simple static storage. Particularly in grafts that are retrieved after cardiac standstill of the donor, provision of oxygen to enable some kind of regenerative metabolism appears to be desirable, although the optimal temperature for oxygenated preservation/revitalization is still under debate. Hybrid solutions, comprising conventional cold storage for ease of graft procurement and transportation together with more sophisticated ‘in-house' reconditioning protocols after arrival at the implantation clinic, might help to minimize graft injury during the critical transition from preservation to reperfusion. © 2014 S. Karger AG, Basel

Comparison of Aerobic Preservation by Venous Systemic Oxygen Persufflation or Oxygenated Machine Perfusion of Warm-Ischemia-Damaged Porcine Kidneys

“…It has been shown that VSOP represents the best method of fully oxygenating an entire human-sized organ when compared with CS, MP, and OMP [11,29,30,31]. Also compared to other techniques, VSOP is a relatively inexpensive and simple technique, with favorable reported results [8,11,32,33,34]. Some drawbacks of VSOP, however, are the potential formation of gaseous emboli and the low potential for waste removal and nutrient supply when compared to MP and OMP [11,35].…”

“…In order to increase the use of less optimal organs for transplantation, aerobic extracorporeal normothermic, subnormothermic, and hypothermic preservation techniques have been developed which demonstrate an improved preservation quality compared to anaerobic preservation for kidney, liver, heart, lung, and pancreas grafts [8,9,10,11,12,13]. The benefit from aerobic preservation has been related to the fact that even at hypothermia, a residual metabolism is operative which has restorative capacities if oxygen is provided [8,14].…”

“…The benefit from aerobic preservation has been related to the fact that even at hypothermia, a residual metabolism is operative which has restorative capacities if oxygen is provided [8,14]. …”

“…For kidney preservation, VSOP was first described by Talbert et al [15] in 1961, and has since then demonstrated the capability of extending the allowable warm and cold ischemia times as well as better maintenance of organ viability when compared to CS and MP [8,11,16]. In the past decades, the feasibility of the clinical application of VSOP was demonstrated in a kidney and a liver preservation feasibility study [17,18].…”

“…In a recent review, it has been postulated that both VSOP and oxygenated machine perfusion (OMP) can exhibit at least a comparable potential for resuscitation of DCD kidneys and livers [11]. Randomized clinical trials are currently in progress to confirm the conceptual expectations that hypothermic reconditioning through aerobic preservation by either VSOP [22] or OMP (COPE-COMPARE trial) can suppress injurious cellular activation cascades and improve postischemic recovery of less-than-optimal organs [8,23]. …”