Reply to ‘Is single portal vein perfusion the best approach for machine preservation of liver grafts?’

Schlegel, Andrea; Kron, Philipp; Oliveira, Michelle; Clavien, Pierre‐Alain; Dutkowski, Philipp

doi:10.1016/j.jhep.2016.01.033

Cited by 8 publications

(8 citation statements)

References 9 publications

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“…1c and d) [39]. This finding correlates well with healthy bile duct epithelia in the distal choledochus 2 weeks after transplantation [40]. Single portal vein approach during cold machine perfusion appears therefore as excellent method delivering oxygen and substrates to the entire biliary epithelia, which has been very recently shown to be of utmost importance for regeneration and protection against later cholangiopathy [30,41].…”

Section: Key Pointssupporting

confidence: 56%

Hypothermic machine perfusion in liver transplantation

Schlegel

Kron

Dutkowski

2016

Current Opinion in Organ Transplantation

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Purpose of the reviewThe purpose of the review is to report recent human application of hypothermic machine liver perfusion, and to discuss potential protective mechanisms. Recent findingsHuman application of hypothermic machine liver perfusion is still very limited. Currently, three transplant centers apply this novel treatment in donation after cardiac death (DCD) or donation after brain death (DBD) liver grafts. In all cases, endischemic perfusion was performed after initial cold storage for organ transport. Perfusion conditions differ slightly in terms of oxygenation (pO 2 15-60 kPa), perfusion route (dual vs. portal), perfusion time (2-4 h), and perfusate. SummaryThe current data support the hypothesis that applying endischemic hypothermic machine liver perfusion protects extended criteria DBD and DCD livers from initial reperfusion injury, with better graft function and less biliary complications. Hypothermic machine perfusion may therefore offer revitalization of liver grafts before implantation by a simple and practical perfusion technique with a high impact on enlarging the donor pool. Multicentric phase III randomized control trials in DBD and DCD liver transplantation have been initiated to further test this strategy, which may establish machine liver perfusion in the clinical setting.

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Section: Key Pointssupporting

confidence: 56%

Hypothermic machine perfusion in liver transplantation

Schlegel

Kron

Dutkowski

2016

Current Opinion in Organ Transplantation

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“…Consistent with these results, hypothermic perfusion including active oxygenation (HOPE) has been shown by our group to be protective in human extended DCD liver grafts, despite very long donor warm ischemia times, with no occurrence of intrahepatic biliary complications in contrast to matched unperfused DCD livers . Importantly, HOPE treatment appeared sufficient by single portal vein perfusion because the entire intrahepatic and extrahepatic biliary system is positively affected through multiple collaterals between the portal vein and hepatic artery . Randomized trials are therefore initiated to further evaluate the effect of HOPE on DBD and DCD liver grafts …”

Section: Hypothermic Perfusion Conceptsupporting

confidence: 60%

“…(31) Importantly, HOPE treatment appeared sufficient by single portal vein perfusion because the entire intrahepatic and extrahepatic biliary system is positively affected through multiple collaterals between the portal vein and hepatic artery. (32,33) Randomized trials are therefore initiated to further evaluate the effect of HOPE on DBD and DCD liver grafts. (34,35) Notably, a HOPE approach was tested recently in Maastricht Type II DCD livers following normothermic regional perfusion, or after extended cold storage.…”

Section: Clinical Datamentioning

confidence: 99%

Advances in hypothermic perfusion

Clavien¹,

Dutkowski²

2017

Liver Transpl

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“…The optimal perfusion route for HOPE (single‐ vs dual HOPE—DHOPE; portal vein only vs portal vein and hepatic artery simultaneously) is still subject of ongoing debate . The optimal preservation of the biliary system remains a critical determinant of long‐term outcome in DCD liver transplantation .…”

Section: Machine Perfusion–basic Principles and Mechanismsmentioning

confidence: 99%

“…The optimal perfusion route for HOPE (single-vs dual HOPE-DHOPE; portal vein only vs portal vein and hepatic artery simultaneously) is still subject of ongoing debate. 88,89 The optimal preservation of the biliary system remains a critical determinant of long-term outcome in DCD liver transplantation. 90 As such, a plead for dual cannulation stems from the perfusion of the peribiliary vascular plexus through branches of the hepatic artery and the fact that its ischaemic/preservation injury frequently causes nonanastomotic biliary strictures (NAS).…”

Section: Hypothermic Oxygenated Machine Perfusion-hopementioning

confidence: 99%

Machine perfusion for liver transplantation in the era of marginal organs—New kids on the block

Czigány

Lurje

Tolba

et al. 2018

Liver International

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In the face of a critical organ shortage in the Western world, various strategies are employed to expand the donor pool for orthotopic liver transplantation (OLT). Among them is the transplantation of organs from extended criteria donors, a valuable source of liver allografts, however, characterized by potential risks for post-OLT complications and inferior outcomes. In recent years, machine perfusion (MP) of the explanted donor liver as well as regional perfusion techniques has witnessed significant advancements. Here, we aim to discuss different modes of dynamic organ preservation in OLT. These include hypothermic and normothermic MP, hypothermic oxygenated machine perfusion (HOPE), controlled oxygenated rewarming as well as regional perfusion protocols. Over recent years, multiple feasibility trials have demonstrated the clinical prospects of MP. In the context of OLT using organs from extended criteria donors, MP has numerous advantages compared to conventional cold storage, some of which include the preservation and reconditioning of borderline transplantable organs and the viability assessment of high-risk donor allografts. This review aims to address the topic of liver allograft MP, highlighting particularly the current trends in clinical applications and future perspectives. Furthermore, different approaches of liver storage and reconditioning are reviewed in the context of ongoing research.

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Reply to ‘Is single portal vein perfusion the best approach for machine preservation of liver grafts?’

Cited by 8 publications

References 9 publications

Hypothermic machine perfusion in liver transplantation

Hypothermic machine perfusion in liver transplantation

Advances in hypothermic perfusion

Machine perfusion for liver transplantation in the era of marginal organs—New kids on the block

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