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Asong-Fontem N, Panisello-Rosello A, Beghdadi N, Lopez A, Rosello-Catafau J, Adam R. Pre-Ischemic Hypothermic Oxygenated Perfusion Alleviates Protective Molecular Markers of Ischemia-Reperfusion Injury in Rat Liver. Transplant Proc 2022; 54:1954-1969. [PMID: 35961798 DOI: 10.1016/j.transproceed.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022]
Abstract
To expand the pool of organs, hypothermic oxygenated perfusion (HOPE), one of the most promising perfusion protocols, is currently performed after cold storage (CS) at transplant centers (HOPE-END). We investigated a new timing for HOPE, hypothesizing that performing HOPE before CS (HOPE-PRE) could boost mitochondrial protection allowing the graft to better cope with the accumulation of oxidative stress during CS. We analyzed liver injuries at 3 different levels. Histologic analysis demonstrated that, compared to classical CS (CTRL), the HOPE-PRE group showed significantly less ischemic necrosis compared to CTRL vs HOPE-END. From a biochemical standpoint, transaminases were lower after 2 hours of reperfusion in the CTRL vs HOPE-PRE group, which marked decreased liver injury. qPCR analysis on 37 genes involved in ischemia-reperfusion injury revealed protection in HOPE-PRE and HOPE-END compared to CTRL mediated through similar pathways. However, the CTRL vs HOPE-PRE group demonstrated an increased transcriptional level for protective genes compared to the CTRL vs HOPE-END group. This study provides insights on novel biomarkers that could be used in the clinic to better characterize graft quality improving transplantation outcomes.
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Affiliation(s)
- Njikem Asong-Fontem
- Université Paris-Saclay, Faculté de Médecine, Unité Chronothérapie, Cancers et Transplantation, Kremlin-Bicêtre, France.
| | - Arnau Panisello-Rosello
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona, Catalonia, Spain
| | - Nassiba Beghdadi
- Université Paris-Saclay, Faculté de Médecine, Unité Chronothérapie, Cancers et Transplantation, Kremlin-Bicêtre, France; Center Hépato-Biliaire, APHP Hôpital Universitaire Paul Brousse, Villejuif, France
| | - Alexandre Lopez
- Université Paris-Saclay, Faculté de Médecine, Unité Chronothérapie, Cancers et Transplantation, Kremlin-Bicêtre, France
| | - Joan Rosello-Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona, Catalonia, Spain
| | - René Adam
- Université Paris-Saclay, Faculté de Médecine, Unité Chronothérapie, Cancers et Transplantation, Kremlin-Bicêtre, France; Center Hépato-Biliaire, APHP Hôpital Universitaire Paul Brousse, Villejuif, France
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2
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Jafari A, Matthaei H, Branchi V, Bölke E, Tolba RH, Kalff JC, Manekeller S. Donor liver quality after hypovolemic shock and venous systemic oxygen persufflation in an experimental animal model. Eur J Med Res 2018; 23:51. [PMID: 30352629 PMCID: PMC6198357 DOI: 10.1186/s40001-018-0346-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/13/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The ever growing demand for liver transplantation inevitably necessitates an expansion of the donor pool. Utilization of "shock organs" is considered suboptimal to date while the associated outcome has hardly been investigated. MATERIALS AND METHODS Male Wistar rats underwent a period of 30 min of hypovolemic shock. After 24 h livers were explanted and prior to reperfusion underwent either 18 h of cold storage (CS; N = 6) or 17 h of CS followed by 60 min venous systemic oxygen persufflation (VSOP; N = 6). The outcome of "shock organs (SHBD)" was compared to heart-beating donor (HBD; N = 12) as positive control and non-heart-beating donor (NHBD; N = 12) as negative control animal groups. Liver function was assessed by measuring enzyme release (AST, ALT, LDH), bile production, portal vein pressure and hepatic oxygen uptake during reperfusion. For reperfusion, the isolated perfused rat liver system was used. RESULTS Liver function was severely limited in NHBD group compared to HBD organs after 18 h of CS (e.g., AST; HBD: 32.25 ± 7.25 U/l vs. NHBD: 790 ± 414.56 U/l; p < 0.005). VSOP improved liver function of NHBD organs significantly (AST; NHBD + VSOP: 333.6 ± 149.1 U/l; p < 0.005). SHBD organs showed a comparable outcome to HBD and clearly better results than NHBD organs after 18 h of CS (AST; SHBD: 76.4 ± 21.9 U/l). After 17 h of CS accompanied by 60 min VSOP, no improvement concerning liver function and integrity of SHBD organs was observed while the results were severely deteriorated by VSOP resulting in higher enzyme release (AST; SHBD + VSOP: 213 ± 61 U/l, p < 0.001), higher portal vein pressure (SHBD: 10.8 ± 1.92 mm Hg vs. SHBD + VSOP: 21.6 ± 8.8 mm Hg; p < 0.05) and lower hepatic oxygen uptake (SHBD: 321.75 ± 3.87 ml/glw/min vs. SHBD + VSOP: 395.8 ± 46.64 ml/glw/min, p < 0.05) at 24 h. CONCLUSIONS Our data suggest that the potential of "shock organs" within liver transplantation may be underestimated. If our findings are reproducable in humans, SHBD grafts should be considered as a valuable source for expanding the thus far limited donor pool.
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Affiliation(s)
- Azin Jafari
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127 Bonn, Germany
| | - Hanno Matthaei
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127 Bonn, Germany
| | - Vittorio Branchi
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127 Bonn, Germany
| | - Edwin Bölke
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Rene H. Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jörg C. Kalff
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127 Bonn, Germany
| | - Steffen Manekeller
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127 Bonn, Germany
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Schlegel A, Dutkowski P. Role of hypothermic machine perfusion in liver transplantation. Transpl Int 2014; 28:677-89. [PMID: 24852621 DOI: 10.1111/tri.12354] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/05/2014] [Accepted: 05/19/2014] [Indexed: 12/15/2022]
Abstract
Machine liver perfusion has significantly evolved during the last ten years to optimize extended criteria liver grafts and to address the worldwide organ shortage. This review gives an overview on available ex vivo and in vivo data on hypothermic machine liver perfusion. We discuss also possible protective pathways and show most recent clinical applications of hypothermic machine liver perfusion in human.
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Affiliation(s)
- Andrea Schlegel
- Department of Visceral Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Dutkowski
- Department of Visceral Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
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Agrawal S, Dhiman RK. Hepatobiliary quiz-9 (2014). J Clin Exp Hepatol 2014; 4:81-4. [PMID: 25755542 PMCID: PMC4188737 DOI: 10.1016/j.jceh.2014.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Radha K. Dhiman
- Address for correspondence: Radha K. Dhiman, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Routh D, Naidu S, Sharma S, Ranjan P, Godara R. Changing pattern of donor selection criteria in deceased donor liver transplant: a review of literature. J Clin Exp Hepatol 2013; 3:337-46. [PMID: 25755521 PMCID: PMC3940395 DOI: 10.1016/j.jceh.2013.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
During the last couple of decades, with standardization and progress in surgical techniques, immunosuppression and post liver transplantation patient care, the outcome of liver transplantation has been optimized. However, the principal limitation of transplantation remains access to an allograft. The number of patients who could derive benefit from liver transplantation markedly exceeds the number of available deceased donors. The large gap between the growing list of patients waiting for liver transplantation and the scarcity of donor organs has fueled efforts to maximize existing donor pool and identify new avenues. This article reviews the changing pattern of donor for liver transplantation using grafts from extended criteria donors (elderly donors, steatotic donors, donors with malignancies, donors with viral hepatitis), donation after cardiac death, use of partial grafts (split liver grafts) and other suboptimal donors (hypernatremia, infections, hypotension and inotropic support).
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Key Words
- CIT, cold ischemia time
- DCD, donation after cardiac death
- DGF, delayed graft function
- ECD, extended criteria donor
- ECMO, extra corporeal membrane oxygenation
- HBIg, hepatitis B immune globulin
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- HTLV, human T-lymphotropic virus
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NRP, normothermic regional perfusion
- PNF, primary nonfunction
- SLT, split liver transplantation
- SOFT, survival outcomes following liver transplantation
- SRTR, Scientific Registry of Transplant Recipients
- donor pool
- extended criteria donor
- liver transplantation
- mTOR, mammalian target of rapamycin inhibitors
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Affiliation(s)
- Dronacharya Routh
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Sudeep Naidu
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India,Address for correspondence: Sudeep Naidu, Professor and Head, Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India. Tel.: +91 (0) 9999454052.
| | - Sanjay Sharma
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Priya Ranjan
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Rajesh Godara
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rhotak, Haryana, India
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6
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Asif S, Sedigh A, Nordström J, Brandhorst H, Jorns C, Lorant T, Larsson E, Magnusson PU, Nowak G, Theisinger S, Hoeger S, Wennberg L, Korsgren O, Brandhorst D. Oxygen-charged HTK-F6H8 emulsion reduces ischemia-reperfusion injury in kidneys from brain-dead pigs. J Surg Res 2012; 178:959-67. [PMID: 22795349 DOI: 10.1016/j.jss.2012.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prolonged cold ischemia is frequently associated with a greater risk of delayed graft function and enhanced graft failure. We hypothesized that media, combining a high oxygen-dissolving capacity with specific qualities of organ preservation solutions, would be more efficient in reducing immediate ischemia-reperfusion injury from organs stored long term compared with standard preservation media. METHODS Kidneys retrieved from brain-dead pigs were flushed using either cold histidine-tryptophan-ketoglutarate (HTK) or oxygen-precharged emulsion composed of 75% HTK and 25% perfluorohexyloctane. After 18 h of cold ischemia the kidneys were transplanted into allogeneic recipients and assessed for adenosine triphosphate content, morphology, and expression of genes related to hypoxia, environmental stress, inflammation, and apoptosis. RESULTS Compared with HTK-flushed kidneys, organs preserved using oxygen-precharged HTK-perfluorohexyloctane emulsion had increased elevated adenosine triphosphate content and a significantly lower gene expression of hypoxia inducible factor-1α, vascular endothelial growth factor, interleukin-1α, tumor necrosis factor-α, interferon-α, JNK-1, p38, cytochrome-c, Bax, caspase-8, and caspase-3 at all time points assessed. In contrast, the mRNA expression of Bcl-2 was significantly increased. CONCLUSIONS The present study has demonstrated that in brain-dead pigs the perfusion of kidneys with oxygen-precharged HTK-perfluorohexyloctane emulsion results in significantly reduced inflammation, hypoxic injury, and apoptosis and cellular integrity and energy content are well maintained. Histologic examination revealed less tubular, vascular, and glomerular changes in the emulsion-perfused tissue compared with the HTK-perfused counterparts. The concept of perfusing organs with oxygen-precharged emulsion based on organ preservation media represents an efficient alternative for improved organ preservation.
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Affiliation(s)
- Sana Asif
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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Perera MTP, Bramhall SR. Current status and recent advances of liver transplantation from donation after cardiac death. World J Gastrointest Surg 2011; 3:167-76. [PMID: 22180833 PMCID: PMC3240676 DOI: 10.4240/wjgs.v3.i11.167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 10/21/2011] [Accepted: 10/28/2011] [Indexed: 02/06/2023] Open
Abstract
The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably “prematurely” offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.
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Affiliation(s)
- M Thamara Pr Perera
- M Thamara PR Perera, Simon R Bramhall, The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom
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8
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Henry SD, Guarrera JV. Protective effects of hypothermic ex vivo perfusion on ischemia/reperfusion injury and transplant outcomes. Transplant Rev (Orlando) 2011; 26:163-75. [PMID: 22074785 DOI: 10.1016/j.trre.2011.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 07/08/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
Hypothermic machine preservation (HMP) has been used in renal transplantation since the late 1960s with recent robust prospective, multicenter data showing lower rates of delayed graft function and improved graft survival. Although now clearly beneficial for renal transplantation, extrarenal machine perfusion has remained predominantly in preclinical investigations. Pancreatic HMP has drawn little clinical interest because HMP has been suggested to cause graft edema and congestion, which is associated with early venous thrombosis and graft failure. Early investigation showed no benefit of HMP in whole-organ pancreas transplant. One report did show that HMP increases islet cell yield after isolation. Preclinical work in liver HMP has been promising. Short- and long-term HMP has been shown to improve graft viability and reduce preservation injury, even in animal models of steatotic and donation after cardiac death. The first clinical study of liver HMP using a centrifugal dual perfusion technique showed excellent results with lower hepatocellular injury markers and no adverse perfusion-related outcomes. In addition, a dramatic attenuation of proinflammatory cytokine expression was observed. Further studies of liver HMP are planned with focus on developing a reproducible and standard protocol that will allow the widespread availability of this technology. Future research and clinical trials of novel organ preservation techniques, solutions, and interventions are likely to bring about developments that will allow further reduction of preservation-related ischemia/reperfusion injury and improved outcomes and allow safer utilization of the precious and limited resource of donor organs.
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Affiliation(s)
- Scot D Henry
- Division of Abdominal Organ Transplantation and Molecular Therapies and Organ Preservation Research Laboratory, Department of Surgery Columbia University Medical Center, New York, NY 10032-3784, USA
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9
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Hosgood SA, Mohamed IH, Bagul A, Nicholson ML. Hypothermic machine perfusion after static cold storage does not improve the preservation condition in an experimental porcine kidney model. Br J Surg 2011; 98:943-50. [DOI: 10.1002/bjs.7481] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Combining hypothermic techniques, as a more practical approach to preservation, may enhance the condition of kidneys donated after cardiac death.
Methods
Porcine kidneys were retrieved after 10 min in situ warm ischaemia, then preserved by either 18 h static cold storage (CS), hypothermic machine perfusion for 18 h (HMP) or 14 h static CS followed by 4 h HMP (4HMP). Kidneys were reperfused for 3 h with oxygenated autologous blood on an isolated organ perfusion system to assess renal function and injury.
Results
Intrarenal resistance was significantly higher in the 4HMP group than in the CS and HMP groups: mean(s.d.) area under the curve (AUC) 8·48(2·97), 3·41(1·80) and 3·78(1·68) mmHg/min.h respectively (P = 0·011). Creatinine clearance was lower after 4HMP and CS: AUC 2·3(0·6) and 2·2(1·7) ml per min per 100g.h respectively versus 9·8(7·3) ml per min per 100g.h in the HMP group (P = 0·022). Levels of endothelin 1 were higher in the 4HMP and CS groups: mean(s.d.) 21·6(4·0) and 24·2(2·3) pg/ml respectively versus 11·4(4·6) pg/ml in the HMP group (P = 0·002). Morphological damage was increased in the 4HMP group.
Conclusion
This porcine kidney study demonstrated no advantage to the addition of 4 h of HMP after CS.
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Affiliation(s)
- S A Hosgood
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - I H Mohamed
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - A Bagul
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - M L Nicholson
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
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Abstract
Perfluorocarbons (PFCs) are inert solutions that have a high capacity for dissolving oxygen. There has been a continuing level of research into the delivery of oxygen during solid organ preservation with the use of PFCs. The one- and two-layer methods have been used as static storage techniques, proving particularly successful for pancreas preservation. They can also be formulated as an emulsion for continual perfusion or as a simple flush solution. The success of PFCs in organ preservation seems to be somewhat organ and species dependant, and further experimental evidence is needed to establish their application.
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Current world literature. Curr Opin Organ Transplant 2009; 14:211-7. [PMID: 19307967 DOI: 10.1097/mot.0b013e32832ad721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Abstract
Ischemia has been an inevitable event accompanying kidney transplantation. Ischemic changes start with brain death, which is associated with severe hemodynamic disturbances: increasing intracranial pressure results in bradycardia and decreased cardiac output; the Cushing reflex causes tachycardia and increased blood pressure; and after a short period of stabilization, systemic vascular resistance declines with hypotension leading to cardiac arrest. Free radical-mediated injury releases proinflammatory cytokines and activates innate immunity. It has been suggested that all of these changes-the early innate response and the ischemic tissue damage-play roles in the development of adaptive responses, which in turn may lead to an acute font of kidney rejection. Hypothermic kidney storage of various durations before transplantation add to ischemic tissue damage. The final stage of ischemic injury occurs during reperfusion. Reperfusion injury, the effector phase of ischemic injury, develops hours or days after the initial insult. Repair and regeneration processes occur together with cellular apoptosis, autophagy, and necrosis; the fate of the organ depends on whether cell death or regeneration prevails. The whole process has been described as the ischemia-reperfusion (I-R) injury. It has a profound influence on not only the early but also the late function of a transplanted kidney. Prevention of I-R injury should be started before organ recovery by donor pretreatment. The organ shortage has become one of the most important factors limiting extension of deceased donor kidney transplantation worldwide. It has caused increasing use of suboptimal deceased donors (high risk, extended criteria [ECD], marginal donors) and uncontrolled non-heart-beating (NHBD) donors. Kidneys from such donors are exposed to much greater ischemic damage before recovery and show reduced chances for proper early as well as long-term function. Storage of kidneys, especially those recovered from ECD (or NHBD) donors, should use machine perfusion.
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Abstract
The number of patients awaiting liver transplantation keeps steadily rising with no corresponding rise in suitable grafts for transplantation. There also is an increasing trend of patients dying or being taken off waiting lists because of deterioration while waiting for a transplant. Over the preceding years the use of marginal grafts in liver transplantation has been driven by the critical shortage of donor organs and by emerging data that their use has resulted in a favourable outcome. This review revisits the factors defining marginality of a graft, and the issues faced by transplant units in making the decision to use such a graft. It also looks at the innovations in transplantation geared towards increasing the donor pool and the resulting issues of matching marginal grafts to suitable recipients.
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Affiliation(s)
- Magdy Attia
- The Liver Unit, University Hospital Birmingham NHS Foundation Trust-Queen Elizabeth, Edgbaston, Birmingham, UK
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14
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Abstract
Due to the critical shortage of deceased donor grafts, clinicians are continually expanding the criteria for an acceptable liver donor to meet the waiting list demands. However, the reduced ischemic tolerance of those extended criteria grafts jeopardizes organ viability during cold storage. Machine perfusion has been developed to limit ischemic liver damage but despite its proven biochemical benefit, machine liver perfusion is not yet considered clinically due to its low practicability. In this review, we summarize our understanding of the role of machine perfusion in marginal liver preservation. The goal is to highlight advantages or disadvantages of current perfusion techniques and to explain the underlying mechanisms. We provide evidence for the need of a liver perfusion performance shortly before implantation, and point out promising designs.
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Affiliation(s)
- P Dutkowski
- Swiss HPB (Hepato-Pancreato-Biliary) Center, Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zurich, Switzerland
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Manekeller S, Seinsche A, Stegemann J, Hirner A. Optimising post-conditioning time of marginal donor livers. Langenbecks Arch Surg 2008; 393:311-6. [PMID: 18283484 DOI: 10.1007/s00423-008-0288-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 01/17/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Due to the discrepancy between organ donors and receptors, the use of marginal livers (e.g., non-heart-beating-donor grafts) for transplantation purpose increased. The potential of a short-term aerobic machine perfusion (post-conditioning) for "less than optimal" grafts after cold storage (CS) was recently demonstrated. In our study, the optimal time course of post-conditioning (PC) is to be evaluated. MATERIALS AND METHODS Livers from male Wistar rats were withdrawn 30 min after cardiac arrest and flushed with histidine tryptophan ketoglutarate (HTK) solution. Then they were stored in HTK at 4 degrees C for 18 h. After 16 h, some livers were put on PC by cold perfusion with HTK for 0.5, 1, 2 or 3 h. Afterwards, the viability of the organs was estimated by warm reperfusion (2 h) in vitro. RESULTS After 1 h of PC, a significant increase in bile production and a decrease in enzyme release could be detected in comparison to CS. The adenosine triphosphate content of the PC livers after 1 h of treatment was significant higher than in CS organs. No markers for apoptosis could be detected after 1 h PC. CONCLUSION It can be concluded that a PC of 1 h after cold storage can ameliorate the organ viability of marginal livers. The extension or abbreviation of PC time seems to have no further beneficial effects.
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Affiliation(s)
- Steffen Manekeller
- Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
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