Superior Preservation of DCD Livers With Continuous Normothermic Perfusion

Fondevila, Constantino; Hessheimer, Amelia J.; Maathuis, Mark-Hugo J.; Muñoz, Javier; Taurà, Pilar; Calatayud, David G.; Leuvenink, Henri G. D.; Rimola, Antoni; Ploeg, Rutger J.; García‐Valdecasas, Juan Carlos

doi:10.1097/sla.0b013e31822b8b2f

Cited by 174 publications

(140 citation statements)

References 37 publications

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“…These findings are important for several reasons. First, NMP is rapidly becoming the subject of preclinical and clinical research (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Second, different research groups have used various perfusion protocols but none have compared their efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Normothermic machine perfusion (NMP) is a preservation technology with potential to prevent both ischemic injury and the deleterious effect of cold temperatures by perfusing organs with a warm oxygenated perfusion solution. Numerous studies have demonstrated the advantage of NMP over CS in the preservation of DCD livers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), suggesting that NMP may greatly benefit the practice of liver transplantation. conducted using whole blood (WB) (9)(10)(11)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc., Denver, CO), Steen plus red blood cells (RBCs), or whole blood (WB). All livers were preserved for 10 h and reperfused to simulate transplantation for 24 h. During preservation, the NMP with Steen group presented the highest hepatocellular injury. At reperfusion, the CS group had the lowest bile production and the worst hepatocellular injury compared with all other groups, followed by NMP with Steen; the Steen plus RBC and WB groups presented the best functional and hepatocellular injury outcomes, with WB livers showing lower aspartate aminotransferase release and a trend toward better results for most parameters. Based on our results, a perfusate that contains an oxygen carrier is most effective in a model of NMP porcine DCD livers compared with Steen solution. Specifically, WB-perfused livers showed a trend toward better outcomes compared with Steen plus RBCs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Liu

Nassar

Farias

et al. 2016

American Journal of Transplantation

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“…Innovative approaches for lowering the biliary mobidity of DCD-LT include thrombolytic agents (83) or machine perfusion (84). First clinical results using backtable injection of tissue plasminogen activator (TPA) into the donor hepatic artery before DCD-LT revealed a low incidence of ischemic cholangiopathy of 9% and an overall biliary complication rate of 27%.…”

Section: Special Issues Of Dcdmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

257

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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“…Research into machine perfusion systems (including in situ and ex situ) is consequently an active field in donor organ recovery and preservation. [45][46][47][48] In 51,52 Compared with ex situ machine perfusion, in situ perfusion is preferable because it obviates the need for exhaustive techniques to reconnect the organs to the machine, increasing simplicity. Additionally, it is an indis-pensable technique that can provide the opportunity to meet legal and logistic requirements for organ recovery without excessive WIT, and depending on the legal opportunities, it can be initiated prior to obtaining consent for organ donation.…”

Section: Liver Preservation Techniquesmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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There are increasing numbers of patients on liver transplant waiting lists, and there is a continuing organ shortage crisis. Therefore, more centers and organ procurement organizations are developing protocols for donation after cardiac death. However, the effect of donation after cardiac death allografts on overall patient survival remains controversial, with some centers reporting equivalent patient posttransplant survival but many others indicating increased rates of complications, retransplant, utilization of resources, and death. Several potential risk factors that predict graft loss and recipient complications have been identified. To improve patient outcomes and reduce dropouts, experimental strategies that target both donors and recipients at various phases of the transplant process have focused on attenuating ischemia-reperfusion injury and have achieved encouraging results. In the present article, our goal is to provide an overview of the current status of, and recent advances in, liver transplant from donation after cardiac death, to better understand the risks and potential benefits of donation after cardiac death liver transplant.

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Superior Preservation of DCD Livers With Continuous Normothermic Perfusion

Abstract: Although 60 minutes recuperative NECMO is better than CS alone, NMP improves further on NECMO and may have a role in preserving DCD livers in the clinical setting.

Cited by 174 publications

References 37 publications

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

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