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Kerforne T, Allain G, Giraud S, Bon D, Ameteau V, Couturier P, Hebrard W, Danion J, Goujon JM, Thuillier R, Hauet T, Barrou B, Jayle C. Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study. Am J Transplant 2019; 19:737-751. [PMID: 30091857 DOI: 10.1111/ajt.15063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as normothermic regional perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30 minutes of cardiac arrest) for 2, 4, or 6 hours compared to a control group (No-NRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to an increased expression of HIF1α-dependent survival pathway. At 2 hours, blood levels of ischemic injury biomarkers increased: creatinine, lactate/pyruvate ratio, LDH, AST, NGAL, KIM-1, CD40 ligand, and soluble-tissue-factor. All these markers then decreased with time; however, AST, NGAL, and KIM-1 increased again at 6 hours. Hemoglobin and platelets decreased at 6 hours, after which the procedure became difficult to maintain. Regarding inflammation, active tissue-factor, cleaved PAR-2 and MCP-1 increased by 4-6 hours, but not TNF-α and iNOS. Compared to No-NRP, NRP kidneys showed lower resistance during hypothermic machine perfusion (HMP), likely associated with pe-NRP eNOS activation. Kidneys transplanted after 4 and 6 hours of NRP showed better function and outcome, compared to No-NRP. In conclusion, our results confirm the mechanistic benefits of NRP and highlight 4 hours as its optimal duration, after which injury markers appear.
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Affiliation(s)
- Thomas Kerforne
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Anesthesia and Intensive Care Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Geraldine Allain
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Sebastien Giraud
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Delphine Bon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Virginie Ameteau
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Pierre Couturier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
| | - William Hebrard
- Unité expérimentale Génétique, Expérimentations et systèmes innovants (GENESI), INRA, Domaine Expérimental du Magneraud, Surgères, France
| | - Jerome Danion
- INSERM U1082, (IRTOMIT), Poitiers, France.,Visceral Surgery Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Jean-Michel Goujon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Pathology Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Raphael Thuillier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Thierry Hauet
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France.,FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', Poitiers, France
| | - Benoit Barrou
- INSERM U1082, (IRTOMIT), Poitiers, France.,Service d'Urologie et de transplantation rénale, AP-HP, GH Pitié-Salpêtrière, Paris, France.,Pierre and Marie Curie Paris VI University, Paris, France
| | - Christophe Jayle
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
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Kahn J, Schemmer P. Control of Ischemia-Reperfusion Injury in Liver Transplantation: Potentials for Increasing the Donor Pool. Visc Med 2018; 34:444-448. [PMID: 30675491 DOI: 10.1159/000493889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Organ shortage is a growing problem, with a rising number of organs being harvested from extended criteria donors, and this trend will further continue to increase as organ donors are getting older and have more comorbidities. Since this fact is immutable, efforts have been made to reduce the extent of ischemia-reperfusion injury (IRI) as well as of direct and indirect harvest-related graft injury which affects all organs in a more or less distinct way. Methods In liver transplantation (LT), the activation of Kupffer cells during organ reperfusion, thus provoking microcirculatory disturbances, hypoxia, and endothelial cell injury, is one of the key mechanisms causing graft dysfunction. Multiple approaches have been taken in order to find efficient preconditioning methods by pharmacological pretreatment, controlled induction of ischemia, controlled denervation of donor organs, and reconditioning with machine perfusion to prevent IRI, whereas marginal organs (i.e. steatotic grafts) are especially vulnerable. Results The above-mentioned approaches have been pursued in experimental and clinical settings. At this time point, however, there is not yet enough clinical evidence available to recommend any particular drug pretreatment or any other intervention for organ preconditioning prior to transplantation. Conclusion The multifactorial pathophysiology in the setting of IRI in LT requires a multimodal therapeutic approach with the integration of pharmacological and technical means being applied to the donor, the organ per se, and the recipient. Currently, there is no consensus on standardized pretreatment of donor organs in order to improve the transplant outcome.
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Affiliation(s)
- Judith Kahn
- Department of General, Visceral and Transplant Surgery, University Hospital, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Department of General, Visceral and Transplant Surgery, University Hospital, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
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Zhong Z, Ye S, Xiong Y, Wu L, Zhang M, Fan X, Li L, Fu Z, Wang H, Chen M, Yan X, Huang W, Ko DSC, Wang Y, Ye Q. Decreased expression of mitochondrial aldehyde dehydrogenase-2 induces liver injury via activation of the mitogen-activated protein kinase pathway. Transpl Int 2015; 29:98-107. [PMID: 26404764 DOI: 10.1111/tri.12675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/31/2015] [Accepted: 08/20/2015] [Indexed: 12/18/2022]
Abstract
The aim of this study was to determine the role of ALDH2 in the injury of liver from brain-dead donors. Using brain-dead rabbit model and hypoxia model, levels of ALDH2 and apoptosis in tissues and cell lines were determined by Western blot, flow cytometry (FCM), and transferase (TdT)-mediated biotin-16-dUTP nick-end labeling (TUNEL) assays. After the expression of ALDH2 during hypoxia had been inhibited or activated, the accumulations of 4-hydroxynonenal (4-HNE) and molecules involved in mitogen-activated protein kinase (MAPK) signaling pathway were analyzed using ELISA kit and Western blot. The low expression of phosphorylated ALDH2 in liver was time-dependent in the brain-dead rabbit model. Immunohistochemistry showed ALDH2 was primarily located in endothelial, and the rates of cell apoptosis in the donation after brain-death (DBD) rabbit groups significantly increased with time. Following the treatment of inhibitor of ALDH2, daidzein, in combination with hypoxia for 8 h, the apoptosis rate and the levels of 4-HNE, P-JNK, and cleaved caspase-3 significantly increased in contrast to that in hypoxic HUVECs; however, they all decreased after treatment with Alda-1 and hypoxia compared with that in hypoxic HUVECs (P < 0.05). Instead, the levels of P-P38, P-ERK, P-JNK, and cleaved caspase-3 decreased and the ratio of bcl-2/bax increased with ad-ALDH2 (10(6) pfu/ml) in combination with hypoxia for 8 h, which significantly alleviated in contrast to that in hypoxic HUVECs. We found low expression of ALDH2 and high rates of apoptosis in the livers of brain-dead donor rabbits. Furthermore, decreased ALDH2 led to apoptosis in HUVECs through MAPK pathway.
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Affiliation(s)
- Zibiao Zhong
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Shaojun Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Yan Xiong
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Lianxi Wu
- Jianghan District Center for Disease Control and Prevention, Wuhan Hubei, China
| | - Meng Zhang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Xiaoli Fan
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Ling Li
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Zhen Fu
- The 3rd Xiangya Hospital of Central South University, Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, China
| | - Huanglei Wang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Mingyun Chen
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Xiaomin Yan
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Wei Huang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Dicken Shiu-Chung Ko
- Massachusetts General Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA
| | - Yanfeng Wang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China
| | - Qifa Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, China.,The 3rd Xiangya Hospital of Central South University, Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, China
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Abstract
BACKGROUND The procurement of the liver is a standardized surgical procedure in the hands of qualified transplantation and organ procurement surgeons which is defined in the German guidelines. METHODS Literature review and discussion of critical aspects concerning the procurement of liver allografts. The procurement of livers should be performed by qualified transplantation and organ procurement surgeons (certification). The technique is standardized in German guidelines. A thoracotomy can help to optimize exposition which is essential to avoid technical complications and injuries to the graft especially in a training situation. Dissection in the cold is recommended. Knowledge of the anatomic variations of the hepatic artery is essential in procuring liver allografts. Documentation of errors and anatomic variations, packing of organs and a standardized closure of the thorax and abdomen are obligations of the responsible leading organ procurement surgeon.
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Affiliation(s)
- A A Schnitzbauer
- Klinik für Allgemein- und Viszeralchirurgie, Zentrum für Chirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Amatschek S, Wilflingseder J, Pones M, Kainz A, Bodingbauer M, Mühlbacher F, Langer RM, Gerlei Z, Oberbauer R. The effect of steroid pretreatment of deceased organ donors on liver allograft function: a blinded randomized placebo-controlled trial. J Hepatol 2012; 56:1305-9. [PMID: 22326464 PMCID: PMC3355301 DOI: 10.1016/j.jhep.2012.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/12/2012] [Accepted: 01/23/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Brain death-associated inflammatory response contributes to increased risk of impaired early liver allograft function, which might be counterbalanced by steroid pretreatment of the organ donor. The aim of this randomized controlled trial was to elucidate whether steroid pretreatment of liver donors improves early liver allograft function, prevents rejection and prolongs survival. METHODS A placebo-controlled blinded randomized clinical trial was performed in three different centers in Austria and Hungary between 2006 and 2008. Ninety deceased organ donors received either 1000 mg of methylprednisolone or placebo 6h before recovery of organs. The primary end point was the concentration slope of transaminases within the first week. The secondary end point included survival and biopsy-confirmed acute rejection (BCAR) within 3 years after transplantation. RESULTS Of the 90 randomized donors, 83 recipients were eligible for study. The trajectories of ALT and AST were not different between treatments (p=0.40 and p=0.13, respectively). Eight subjects died in the steroid and 13 in the placebo group within 3 years after engraftment (RR=0.63 95% CI [0.29,1.36], p=0.31). Eleven recipients experienced biopsy-confirmed rejection (BCAR) in the steroid and 11 in the placebo group (RR=1.02 95% CI [0.50,2.10], p=1.00). No effect modification could be identified in the predefined strata of donor age, sex, cold ischemic time, and cause of donor death. CONCLUSIONS Steroid pretreatment of organ donors did not improve outcomes after liver transplantation.
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Affiliation(s)
- Stefan Amatschek
- KH Elisabethinen, Linz, Austria,Department of Internal Medicine 3, Medical University of Vienna, Austria
| | - Julia Wilflingseder
- KH Elisabethinen, Linz, Austria,Department of Internal Medicine 3, Medical University of Vienna, Austria
| | - Mario Pones
- Department of Transplantation, Medical University of Vienna, Austria
| | - Alexander Kainz
- KH Elisabethinen, Linz, Austria,Department of Internal Medicine 3, Medical University of Vienna, Austria
| | | | | | - Robert M. Langer
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Gerlei
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Rainer Oberbauer
- KH Elisabethinen, Linz, Austria,Department of Internal Medicine 3, Medical University of Vienna, Austria,Corresponding author. Address: Department of Internal Medicine 3, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria. Tel.: +43 1 40400 4390; fax: +43 1 40400 4392.
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