Role of perfusion machines in the setting of clinical liver transplantation: A qualitative systematic review

Lai, Quirino; Melandro, Fabio; Rossi, Massimo; Ruberto, Franco; Pugliese, Francesco; Mennini, Gianluca

doi:10.1111/ctr.13310

Cited by 6 publications

(4 citation statements)

References 55 publications

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“…In addition, CTA can provide and respond well to the information of hemodynamic changes, vascular lesion morphology, vascular stenosis, and thrombosis in ITBL patients. Therefore, it is gradually widely used in the diagnosis of ITBL patients and even tends to replace DSA [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation

Wang

et al. 2022

Computational and Mathematical Methods in Medicine

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The study focused on the clinical application value of artificial intelligence-based computed tomography angiography (CTA) in the diagnosis of orthotopic liver transplantation (OLT) after ischemic type biliary lesions (ITBL). A total of 66 patients receiving OLT in hospital were selected. Convolutional neural network (CNN) algorithm was used to denoise and detect the edges of CTA images of patients. At the same time, the quality of the processed image was subjectively evaluated and quantified by Hmax, Ur, Cr, and other indicators. Then, the digital subtraction angiography (DSA) diagnosis and CTA diagnosis based on CNN were compared for the sensitivity, specificity, positive predictive value, negative predictive value, and patient classification results. It was found that CTA can clearly reflect the information of hepatic aorta lesions and thrombosis in patients with ischemic single-duct injury after liver transplantation. After neural network algorithm processing, the image quality is obviously improved, the lesions are more prominent, and the details of lesion parts are also well displayed. ITBL occurred in 40 (71%) of 56 patients with abnormal CTA at early stage. ITBL occurred in only 8 (12.3%) of 65 patients with normal CTA at early stage. Early CTA manifestations had high sensitivity (72.22%), specificity (87.44%), positive predictive value (60.94%), and negative predictive value (92.06%) for the diagnosis of ITBL. It was concluded that artificial intelligence-based CTA had high clinical application value in the diagnosis of ITBL after OLT.

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Section: Discussionmentioning

confidence: 99%

Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation

Wang

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Univariate analysis has confirmed the utility of MP as widely mentioned in the literature (9,17,(22)(23)(24): grafts from elderly donors, or with those with very high BMI, or with deranged laboratory test can be saved by MP (Table 1). In fact, recently a trial has indeed shown that HMP definitely reduces ischemia reperfusion injury in ECD compared with grafts from SCD (17).…”

Section: Discussion Negative and Positive Eventsmentioning

confidence: 57%

How useful is the machine perfusion in liver transplantation? An answer from a national survey

Scalera¹,

Carlis

Patrono

et al. 2022

Front. Surg.

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Machine perfusion (MP) has been shown worldwide to offer many advantages in liver transplantation, but it still has some gray areas. The purpose of the study is to evaluate the donor risk factors of grafts, perfused with any MP, that might predict an ineffective MP setting and those would trigger post-transplant early allograft dysfunction (EAD). Data from donors of all MP-perfused grafts at six liver transplant centers have been analyzed, whether implanted or discarded after perfusion. The first endpoint was the negative events after perfusion (NegE), which is the number of grafts discarded plus those that were implanted but lost after the transplant. A risk factor analysis for NegE was performed and marginal grafts for MP were identified. Finally, the risk of EAD was analyzed, considering only implanted grafts. From 2015 to September 2019, 158 grafts were perfused with MP: 151 grafts were implanted and 7 were discarded after the MP phase because they did not reach viability criteria. Of 151, 15 grafts were lost after transplant, so the NegE group consisted of 22 donors. In univariate analysis, the donor risk index >1.7, the presence of hypertension in the medical history, static cold ischemia time, and the moderate or severe macrovesicular steatosis were the significant factors for NegE. Multivariate analysis confirmed that macrosteatosis >30% was an independent risk factor for NegE (odd ratio 5.643, p = 0.023, 95% confidence interval, 1.27–24.98). Of 151 transplanted patients, 34% experienced EAD and had worse 1- and 3-year-survival, compared with those who did not face EAD (NoEAD), 96% and 96% for EAD vs. 89% and 71% for NoEAD, respectively (p = 0.03). None of the donor/graft characteristics was associated with EAD even if the graft was moderately steatotic or fibrotic or from an aged donor. For the first time, this study shows that macrovesicular steatosis >30% might be a warning factor involved in the risk of graft loss or a cause of graft discard after the MP treatment. On the other hand, the MP seems to be useful in reducing the donor and graft weight in the development of EAD.

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“…The additional time required for COVID-19 testing of donors and recipients may delay organ procurement and lower the utilization rate especially of hemodynamically unstable donors that normally require fast-track management to minimize organs damage. Machine perfusion for organ preservation is expanding in almost all solid organs transplantation, allowing extend preservation time in liver, kidney, lung and heart transplantation [8,9]. Machine perfusion could come into help when organs need to be retrieved quickly and preserved while virus tests are processed, in particular in unstable donors with low-risk history for COVID-19.…”

Section: Timing and Logistics Of Transplantationmentioning

confidence: 99%

Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger

et al. 2020

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The global health crisis due to the fast spread of coronavirus disease (COVID-19) has caused major disruption in all aspects of healthcare. Transplantation is one of the most affected sectors, as it relies on a variety of services that have been drastically occupied to treat patients affected by COVID-19. With this report from two transplant centers in Italy, we aim to reflect on resource organization, organ allocation, virus testing and transplant service provision during the course of the pandemic and to provide actionable information highlighting advantages and drawbacks. To what extent can we preserve the noble purpose of transplantation in times of increased danger? Strategies to minimize risk exposure to the transplant population and health-workers include systematic virus screening, protection devices, social distancing and reduction of patients visits to the transplant center. While resources for the transplant activity are inevitably reduced, new dilemmas arise to the transplant community: further optimization of time constraints during organ retrievals and implantation, less organs and blood products donated, limited space in the intensive care unit and the duty to maintain safety and outcomes.

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Role of perfusion machines in the setting of clinical liver transplantation: A qualitative systematic review

Abstract: Until now, no study exists that addresses the role of MP in selecting liver grafts available for LT. All the published studies mainly focused on the feasibility and safety of this new technology. Further research investigating the selection process of marginal donors is required.

Cited by 6 publications

References 55 publications

Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation

Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation

How useful is the machine perfusion in liver transplantation? An answer from a national survey

Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger

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