Normothermic ex-vivo liver perfusion: where do we stand and where to reach?

Abstract

Nowadays liver transplantation is considered as the treatment of choice, however, the scarcity of suitable donor organs limits the delivery of care to the end-stage liver disease patients leading to the death while on the waiting list. The advent of ex-situ normothermic machine perfusion (NMP) has emerged as an alternative to the standard organ preservation technique, static cold storage (SCS). The newer technique promises to not only restore the normal metabolic activity but also attempt to recondition the marginal livers back to the pristine state, which are otherwise more susceptible to ischemic injury and foster the poor post-transplant outcomes. Areas covered: An extensive search of all the published literature describing the role of NMP based device in liver transplantation as an alternative to SCS was made on MEDLINE, EMBASE, Cochrane, BIOSIS, Crossref, Scopus databases and clinical trial registry on 10 May 2018. Expert commentary: The main tenet of NMP is the establishment of the physiological milieu, which permits aerobic metabolism to continue through out the period of preservation and limits the effects of ischemia-reperfusion (I/R) injury. In addition, by assessing the various metabolic and synthetic parameters the viability and suitability of donor livers for transplantation can be determined. This important technological advancement has scored satisfactorily on the safety and efficacy parameters in preliminary clinical studies. The present review suggests that NMP can offer the opportunity to assess and safely utilize the marginal donor livers if deemed appropriate for the transplantation. However, ongoing trials will determine its full potential and further adoption.

Cytochrome P450 2E1 predicts liver functional recovery from donation after circulatory death using air-ventilated normothermic machine perfusion

“…Firstly, we selected the perfusion period of 120 min according to the most used animal study and clinical practices. The longer-term perfusion, which may further improve perfusion effect 30 , was not employed in the current study. Another consideration is the selection of the liver functional parameters.…”

The impact of short-term machine perfusion on the risk of cancer recurrence after rat liver transplantation with donors after circulatory death

“…Hypothermic and normothermic perfusions proved effective in rescuing liver grafts from ischemic injuries[1, 12–14, 17, 27, 28]. While the former is simpler approach that requires no blood or additives, the latter has the advantage of mimicking physiological conditions, but requires more sophisticated equipment and involves higher costs[29]. Given that there is no consensus on whether one strategy is more effective than the other[30], and none of them was tested in a cancer setting, we challenged both.…”

The Human Immune Response to Cadaveric and Living Donor Liver Allografts

“…Intraoperative cardiovascular instability can occur immediately following re-establishment of blood flow due to a large efflux of metabolic substrates from the damaged liver, this entity is known as postreperfusion syndrome (PRS) (36). Release of cytokines (Tumor necrosis factor-α, IL-1, Interferon-γ, tumor necrosis factor-β) results in the accumulation of neutrophils (35).…”