Sequential Use of Normothermic Regional Perfusion and Hypothermic Machine Perfusion in Donation After Cardiac Death Liver Transplantation With Extended Warm Ischemia Time

Carlis, Luciano De; Carlis, Riccardo De; Lauterio, Andrea; Sandro, Stefano Di; Ferla, Fabio; Zanierato, Marinella

doi:10.1097/tp.0000000000001419

Cited by 41 publications

(31 citation statements)

References 4 publications

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“…(7,24,37) The feasibility of combining variant perfusion techniques has been suggested before, though the advantages, caveats, and logistics aspects of different combinations are yet to be seen. (38) The current study is the first to show a combined protocol of HOPE + NMP that might be easily adopted to clinical practice. A short-term HOPE phase optimizes mitochondrial oxidative function, decreasing tissue oxidative injury and the downstream activation of the inflammatory cascade during reperfusion.…”

Section: Discussionmentioning

confidence: 91%

Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

Boteon

Laing

Schlegel³

et al. 2018

Liver Transpl

105

108

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Hypothermic oxygenated perfusion (HOPE) and normothermic perfusion are seen as distinct techniques of ex situ machine perfusion of the liver. We aimed to demonstrate the feasibility of combining both techniques and whether it would improve functional parameters of donor livers into transplant standards. Ten discarded human donor livers had either 6 hours of normothermic perfusion (n = 5) or 2 hours of HOPE followed by 4 hours of normothermic perfusion (n = 5). Liver function was assessed according to our viability criteria; markers of tissue injury and hepatic metabolic activity were compared between groups. Donor characteristics were comparable. During the hypothermic perfusion phase, livers down-regulated mitochondrial respiration (oxygen uptake, P = 0.04; partial pressure of carbon dioxide perfusate, P = 0.04) and increased adenosine triphosphate levels 1.8-fold. Following normothermic perfusion, those organs achieved lower tissue expression of markers of oxidative injury (4-hydroxynonenal, P = 0.008; CD14 expression, P = 0.008) and inflammation (CD11b, P = 0.02; vascular cell adhesion molecule 1, P = 0.05) compared with livers that had normothermic perfusion alone. All livers in the combined group achieved viability criteria, whereas 40% (2/5) in the normothermic group failed (P = 0.22). In conclusion, this study suggests that a combined protocol of hypothermic oxygenated and normothermic perfusions might attenuate oxidative stress, tissue inflammation, and improve metabolic recovery of the highest-risk donor livers compared with normothermic perfusion alone.

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Section: Discussionmentioning

confidence: 91%

Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

Boteon

Laing

Schlegel³

et al. 2018

Liver Transpl

105

108

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“…Of the remaining 267, 240 were not considered eligible for full‐text evaluation. Eventually, 27 articles with a total number of 173 patients were reported on clinical LT using MP . Some articles from the same center showed partial overlapping of reported cases: consequently, the global number of patients for each center was extrapolated after careful evaluation of the reported series, typically taking into consideration the most recent study.…”

Section: Resultsmentioning

confidence: 99%

“…Since then, multiple experiences have been reported worldwide, fostering high expectations concerning the following implementation of MPs into clinical practice . However, several obstacles, as the necessity of finding objective MP‐related variables to select grafts suitable for LT, still stand.…”

Section: Introductionmentioning

confidence: 99%

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

Lai

Melandro

Rossi

et al. 2018

Clinical Transplantation

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“…In this regard, different perfusion methods may evolve into complementary or even additive approaches. While this hypothesis has not yet been considered in any clinical trial, a case report from De Carlis et al describes the successful application of HMP to a DCD Type II donor after NRP. Similarly, only few comparative assessments have hitherto been performed in animal studies, without any mid‐ or long‐term observation of animals …”

Section: Future Perspectives and Remaining Challengesmentioning

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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Sequential Use of Normothermic Regional Perfusion and Hypothermic Machine Perfusion in Donation After Cardiac Death Liver Transplantation With Extended Warm Ischemia Time

Cited by 41 publications

References 4 publications

Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

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

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

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