Organ preservation: from the past to the future

Abstract

Organ transplantation is the most effective therapy for patients with end-stage disease. Preservation solutions and techniques are crucial for donor organ quality, which is directly related to morbidity and survival after transplantation. Currently, static cold storage (SCS) is the standard method for organ preservation. However, preservation time with SCS is limited as prolonged cold storage increases the risk of early graft dysfunction that contributes to chronic complications. Furthermore, the growing demand for the use of marginal donor organs requires methods for organ assessment and repair. Machine perfusion has resurfaced and dominates current research on organ preservation. It is credited to its dynamic nature and physiological-like environment. The development of more sophisticated machine perfusion techniques and better perfusates may lead to organ repair/reconditioning. This review describes the history of organ preservation, summarizes the progresses that has been made to date, and discusses future directions for organ preservation.

Machine Perfusion of Extended Criteria Donor Organs: Immunological Aspects

“…For more than 50 years, static cold storage (SCS) was the gold standard method for organ preservation until the interest in the concept of organ machine perfusion (MP) was renewed (10). To date, a significant number of experimental and clinical trials were published demonstrating increasing support of MP as a more physiologic method of solid organ preservation compared to SCS (11)(12)(13)(14)(15).…”

“…Older donor organs have higher immunogenicity, mediated by poorer monocyte clearance of damaged necrotic cells, and therefore recipients may require a more intense immunosuppression in the early period after Tx (19)(20)(21)(22). Knowing about the ECD grafts' increased risk for poor function or failure (23)(24)(25), implementation of new storage techniques, such as MP, paved the way for better characterization of organ quality and the possibility for graft reconditioning before Tx to improve organ vulnerability and immunogenicity (10,26).…”

“…Figure 2 summarizes frequently described MP settings including the underlying mechanisms. Briefly, hypothermic MP (HMP, 4-10 • C) is based on the concept that oxidative energy production by mitochondrial electron transport is sustained at reduced rates by keeping low temperatures (10). In contrast, normothermic MP (NMP, 37 • C) aims to provide an approximately near physiological environment for organs ex vivo (37).…”

Optimizing Livers for Transplantation Using Machine Perfusion versus Cold Storage in Large Animal Studies and Human Studies: A Systematic Review and Meta-Analysis

“…Cold static storage (CS) has become the primary organ preservation strategy since the development of specialized preservation solutions, especially the University of Wisconsin (UW) solution [ 1 ]. However, there are several limitations to CS, including cold ischemia-related organ damage, difficulty assessing donor organ function and viability before the transplant and limited opportunity to repair organ function [ 2 , 3 ].…”

A new platform for international collaboration on pharmacology and drug development: 2017 China-Canada-USA Pharmacology/Physiology Conference

“…They concluded that the contact inhibition of vascular smooth muscle cells may represent a novel therapeutic approach for vascular disease [19] . In addition, Mingyao Liu group from the University of Toronto reviewed the history and current progress of organ preservation, and discussed the future directions of the most effective therapy for patients with end-stage diseases to meet the increased demands in medical practice [20] .…”