1
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Mahboub P, Aburawi M, Ozgur OS, Pendexter C, Cronin S, Lin FM, Jain R, Karabacak MN, Karimian N, Tessier SN, Markmann JF, Yeh H, Uygun K. Gradual rewarming with a hemoglobin-based oxygen carrier improves viability of donation after circulatory death in rat livers. FRONTIERS IN TRANSPLANTATION 2024; 3:1353124. [PMID: 38993754 PMCID: PMC11235298 DOI: 10.3389/frtra.2024.1353124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/10/2024] [Indexed: 07/13/2024]
Abstract
Background Donation after circulatory death (DCD) grafts are vital for increasing available donor organs. Gradual rewarming during machine perfusion has proven effective in mitigating reperfusion injury and enhancing graft quality. Limited data exist on artificial oxygen carriers as an effective solution to meet the increasing metabolic demand with temperature changes. The aim of the present study was to assess the efficacy and safety of utilizing a hemoglobin-based oxygen carrier (HBOC) during the gradual rewarming of DCD rat livers. Methods Liver grafts were procured after 30 min of warm ischemia. The effect of 90 min of oxygenated rewarming perfusion from ice cold temperatures (4 °C) to 37 °C with HBOC after cold storage was evaluated and the results were compared with cold storage alone. Reperfusion at 37 °C was performed to assess the post-preservation recovery. Results Gradual rewarming with HBOC significantly enhanced recovery, demonstrated by markedly lower lactate levels and reduced vascular resistance compared to cold-stored liver grafts. Increased bile production in the HBOC group was noted, indicating improved liver function and bile synthesis capacity. Histological examination showed reduced cellular damage and better tissue preservation in the HBOC-treated livers compared to those subjected to cold storage alone. Conclusion This study suggests the safety of using HBOC during rewarming perfusion of rat livers as no harmful effect was detected. Furthermore, the viability assessment indicated improvement in graft function.
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Affiliation(s)
- Paria Mahboub
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Mohamed Aburawi
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
- Transplant Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - O Sila Ozgur
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Casie Pendexter
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Stephanie Cronin
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Florence Min Lin
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Rohil Jain
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Murat N Karabacak
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Negin Karimian
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - Shannon N Tessier
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
| | - James F Markmann
- Transplant Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Heidi Yeh
- Transplant Center, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Research, Shriners Hospitals for Children, Boston, MA, United States
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2
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Kulik U, Moesta C, Spanel R, Borlak J. Dysfunctional Cori and Krebs cycle and inhibition of lactate transporters constitute a mechanism of primary nonfunction of fatty liver allografts. Transl Res 2024; 264:33-65. [PMID: 37722450 DOI: 10.1016/j.trsl.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
Orthotopic liver transplantation (OLT) is a lifesaving procedure. However, grafts may fail due to primary nonfunction (PNF). In the past, we demonstrated PNFs to be mainly associated with fatty allografts, and given its unpredictable nature, the development of a disease model is urgently needed. In an effort to investigate mechanism of fatty allograft-associated PNFs, we induced fatty liver disease in donor animals by feeding rats a diet deficient in methionine and choline (MCD). We performed OLT with allografts of different grades of hepatic steatosis and compared the results to healthy ones. We assessed liver function by considering serum biochemistries, and investigated genome wide responses following OLT of healthy and fatty allograft-associated PNFs. Furthermore, we performed immunohistochemistry to evaluate markers of oxidative stress and reperfusion injury, inflammation, glycolysis and gluconeogenesis, lactate transport, and its utilization as part of the Cori cycle. Strikingly, PNFs are strictly lipid content dependent. Nonetheless, a fat content of ≤17% and an increase in the size of hepatocytes of ≤11% (ballooning) greatly improved outcome of OLTs and the hepatic microcirculation. Mechanistically, PNFs arise from a dysfunctional Cori cycle with complete ablation of the lactate transporter SLC16A1. Thus, lipid-laden hepatocytes fail to perform gluconeogenesis via lactate reutilization, and the resultant hyperlactatemia and lactic acidosis causes cardiac arrhythmogenicity and death. Furthermore, the genomic and immunohistochemistry investigations underscore a dysfunctional Krebs cycle with impaired energy metabolism in lipid-burdened mitochondria. Together, we show fatty allografts to be highly vulnerable towards ischemia/reperfusion-injury, and stabilizing the Cori cycle is of critical importance to avert PNFs.
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Affiliation(s)
- Ulf Kulik
- Department of General, Visceral- and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Caroline Moesta
- Centre for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany
| | - Reinhard Spanel
- Centre for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany
| | - Jürgen Borlak
- Centre for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany.
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3
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Longchamp A, Nakamura T, Uygun K, Markmann JF. Role of Machine Perfusion in Liver Transplantation. Surg Clin North Am 2024; 104:45-65. [PMID: 37953040 DOI: 10.1016/j.suc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Given the current severe shortage of available livers for transplantation, there is an urgent need to maximize the utilization of donor organs. One of the strategies to increase the number of available livers for transplantation is to improve organ utilization through the use of elderly, overweight, or organs donated after circulatory death. However, the utilization of these "marginal" organs was associated with an increased risk of early allograft dysfunction, primary nonfunction, ischemic biliary complications, or even re-transplantation. Ischemia-reperfusion injury is a key mechanism in the pathogenesis of these complications.
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Affiliation(s)
- Alban Longchamp
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsukasa Nakamura
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Korkut Uygun
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James F Markmann
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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4
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Ozgur OS, Namsrai BE, Pruett TL, Bischof JC, Toner M, Finger EB, Uygun K. Current practice and novel approaches in organ preservation. FRONTIERS IN TRANSPLANTATION 2023; 2:1156845. [PMID: 38993842 PMCID: PMC11235303 DOI: 10.3389/frtra.2023.1156845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/16/2023] [Indexed: 07/13/2024]
Abstract
Organ transplantation remains the only treatment option for patients with end-stage organ failure. The last decade has seen a flurry of activity in improving organ preservation technologies, which promise to increase utilization in a dramatic fashion. They also bring the promise of extending the preservation duration significantly, which opens the doors to sharing organs across local and international boundaries and transforms the field. In this work, we review the recent literature on machine perfusion of livers across various protocols in development and clinical use, in the context of extending the preservation duration. We then review the next generation of technologies that have the potential to further extend the limits and open the door to banking organs, including supercooling, partial freezing, and nanowarming, and outline the opportunities arising in the field for researchers in the short and long term.
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Affiliation(s)
- Ozge Sila Ozgur
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Research Department, Shriners Children’s Boston, Boston, MA, United States
| | - Bat-Erdene Namsrai
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Timothy L. Pruett
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - John C. Bischof
- Departments of Mechanical and Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Mehmet Toner
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Research Department, Shriners Children’s Boston, Boston, MA, United States
| | - Erik B. Finger
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Korkut Uygun
- Department of Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Research Department, Shriners Children’s Boston, Boston, MA, United States
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5
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Tessier SN, de Vries RJ, Pendexter CA, Cronin SEJ, Ozer S, Hafiz EOA, Raigani S, Oliveira-Costa JP, Wilks BT, Lopera Higuita M, van Gulik TM, Usta OB, Stott SL, Yeh H, Yarmush ML, Uygun K, Toner M. Partial freezing of rat livers extends preservation time by 5-fold. Nat Commun 2022; 13:4008. [PMID: 35840553 PMCID: PMC9287450 DOI: 10.1038/s41467-022-31490-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
The limited preservation duration of organs has contributed to the shortage of organs for transplantation. Recently, a tripling of the storage duration was achieved with supercooling, which relies on temperatures between -4 and -6 °C. However, to achieve deeper metabolic stasis, lower temperatures are required. Inspired by freeze-tolerant animals, we entered high-subzero temperatures (-10 to -15 °C) using ice nucleators to control ice and cryoprotective agents (CPAs) to maintain an unfrozen liquid fraction. We present this approach, termed partial freezing, by testing gradual (un)loading and different CPAs, holding temperatures, and storage durations. Results indicate that propylene glycol outperforms glycerol and injury is largely influenced by storage temperatures. Subsequently, we demonstrate that machine perfusion enhancements improve the recovery of livers after freezing. Ultimately, livers that were partially frozen for 5-fold longer showed favorable outcomes as compared to viable controls, although frozen livers had lower cumulative bile and higher liver enzymes.
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Affiliation(s)
- Shannon N. Tessier
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Reinier J. de Vries
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Centers – location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Casie A. Pendexter
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,Present Address: Sylvatica Biotech Inc., North Charleston, SC USA
| | - Stephanie E. J. Cronin
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Sinan Ozer
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Ehab O. A. Hafiz
- grid.420091.e0000 0001 0165 571XDepartment of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Siavash Raigani
- grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, MA USA
| | - Joao Paulo Oliveira-Costa
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA USA
| | - Benjamin T. Wilks
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Manuela Lopera Higuita
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Thomas M. van Gulik
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Centers – location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Osman Berk Usta
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Shannon L. Stott
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA USA
| | - Heidi Yeh
- grid.32224.350000 0004 0386 9924Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, MA USA
| | - Martin L. Yarmush
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA ,grid.430387.b0000 0004 1936 8796Department of Biomedical Engineering, Rutgers University, Piscataway, NJ USA
| | - Korkut Uygun
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
| | - Mehmet Toner
- grid.38142.3c000000041936754XCenter for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA USA ,grid.415829.30000 0004 0449 5362Shriners Hospitals for Children Boston, Boston, MA USA
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6
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Lucia A, Ferrarese E, Uygun K. Modeling energy depletion in rat livers using Nash equilibrium metabolic pathway analysis. Sci Rep 2022; 12:3496. [PMID: 35241684 PMCID: PMC8894355 DOI: 10.1038/s41598-022-06966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
The current gold standard of Static Cold Storage (SCS), which is static cold storage on ice (about + 4 °C) in a specialized media such as the University of Wisconsin solution (UW), limits storage to few hours for vascular and metabolically active tissues such as the liver and the heart. The liver is arguably the pinnacle of metabolism in human body and therefore metabolic pathway analysis immediately becomes very relevant. In this article, a Nash Equilibrium (NE) approach, which is a first principles approach, is used to model and simulate the static cold storage and warm ischemia of a proposed model of liver cells. Simulations of energy depletion in the liver in static cold storage measured by ATP content and energy charge are presented along with comparisons to experimental data. In addition, conversion of Nash Equilibrium iterations to time are described along with an uncertainty analysis for the parameters in the model. Results in this work show that the Nash Equilibrium approach provides a good match to experimental data for energy depletion and that the uncertainty in model parameters is very small with percent variances less than 0.1%.
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Affiliation(s)
- Angelo Lucia
- Department of Chemical Engineering, University of Rhode Island, Kington, RI, 02881, USA.
| | - Emily Ferrarese
- Department of Chemical Engineering, University of Rhode Island, Kington, RI, 02881, USA
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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7
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Burlage LC, Lellouch AG, Taveau CB, Tratnig-Frankl P, Pendexter CA, Randolph MA, Porte RJ, Lantieri LA, Tessier SN, Cetrulo CL, Uygun K. Optimization of Ex Vivo Machine Perfusion and Transplantation of Vascularized Composite Allografts. J Surg Res 2022; 270:151-161. [PMID: 34670191 PMCID: PMC8712379 DOI: 10.1016/j.jss.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Machine perfusion is gaining interest as an efficient method of tissue preservation of Vascularized Composite Allografts (VCA). The aim of this study was to develop a protocol for ex vivo subnormothermic oxygenated machine perfusion (SNMP) on rodent hindlimbs and to validate our protocol in a heterotopic hindlimb transplant model. METHODS In this optimization study we compared three different solutions during 6 h of SNMP (n = 4 per group). Ten control limbs were stored in a preservation solution on Static Cold Storage [SCS]). During SNMP we monitored arterial flowrate, lactate levels, and edema. After SNMP, muscle biopsies were taken for histology examination, and energy charge analysis. We validated the best perfusion protocol in a heterotopic limb transplantation model with 30-d follow up (n = 13). As controls, we transplanted untreated limbs (n = 5) and hindlimbs preserved with either 6 or 24 h of SCS (n = 4 and n = 5). RESULTS During SNMP, arterial outflow increased, and lactate clearance decreased in all groups. Total edema was significantly lower in the HBOC-201 group compared to the BSA group (P = 0.005), 4.9 (4.3-6.1) versus 48.8 (39.1-53.2) percentage, but not to the BSA + PEG group (P = 0.19). Energy charge levels of SCS controls decreased 4-fold compared to limbs perfused with acellular oxygen carrier HBOC-201, 0.10 (0.07-0.17) versus 0.46 (0.42-0.49) respectively (P = 0.002). CONCLUSIONS Six hours ex vivo SNMP of rodent hindlimbs using an acellular oxygen carrier HBOC-201 results in superior tissue preservation compared to conventional SCS.
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Affiliation(s)
- Laura C Burlage
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Department of Surgery, University Medical Center Groningen, Groningen, Netherlands; Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts.
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, European George Pompidou Hospital, University of Paris, Paris, France
| | - Corentin B Taveau
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Philipp Tratnig-Frankl
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Casie A Pendexter
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Mark A Randolph
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Robert J Porte
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Laurent A Lantieri
- Division of Plastic and Reconstructive Surgery within the Department of Surgery, European George Pompidou Hospital, University of Paris, Paris, France
| | - Shannon N Tessier
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery within the Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children, Boston, Massachusetts
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8
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de Vries RJ, Cronin SEJ, Romfh P, Pendexter CA, Jain R, Wilks BT, Raigani S, van Gulik TM, Chen P, Yeh H, Uygun K, Tessier SN. Non-invasive quantification of the mitochondrial redox state in livers during machine perfusion. PLoS One 2021; 16:e0258833. [PMID: 34705828 PMCID: PMC8550443 DOI: 10.1371/journal.pone.0258833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Ischemia reperfusion injury (IRI) is a critical problem in liver transplantation that can lead to life-threatening complications and substantially limit the utilization of livers for transplantation. However, because there are no early diagnostics available, fulminant injury may only become evident post-transplant. Mitochondria play a central role in IRI and are an ideal diagnostic target. During ischemia, changes in the mitochondrial redox state form the first link in the chain of events that lead to IRI. In this study we used resonance Raman spectroscopy to provide a rapid, non-invasive, and label-free diagnostic for quantification of the hepatic mitochondrial redox status. We show this diagnostic can be used to significantly distinguish transplantable versus non-transplantable ischemically injured rat livers during oxygenated machine perfusion and demonstrate spatial differences in the response of mitochondrial redox to ischemia reperfusion. This novel diagnostic may be used in the future to predict the viability of human livers for transplantation and as a tool to better understand the mechanisms of hepatic IRI.
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Affiliation(s)
- Reinier J. de Vries
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
- Department of Surgery, Amsterdam University Medical Centers–Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie E. J. Cronin
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Padraic Romfh
- Pendar Technologies, Cambridge, MA, United States of America
| | - Casie A. Pendexter
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Rohil Jain
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Benjamin T. Wilks
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Siavash Raigani
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | - Thomas M. van Gulik
- Department of Surgery, Amsterdam University Medical Centers–Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peili Chen
- Pendar Technologies, Cambridge, MA, United States of America
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
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9
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Integrative Network Analysis Revealed Genetic Impact of Pyruvate Kinase L/R on Hepatocyte Proliferation and Graft Survival after Liver Transplantation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:7182914. [PMID: 34512869 PMCID: PMC8429008 DOI: 10.1155/2021/7182914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background Pyruvate kinase L/R (PKLR) has been suggested to affect the proliferation of hepatocytes via regulation of the cell cycle and lipid metabolism. However, its impact on the global metabolome and its clinical implications remain unclear. Aims We aimed to clarify the genetic impact of PKLR on the metabolomic profiles of hepatoma cells and its potential effects on grafts for liver transplantation (LT). Methods Nontargeted and targeted metabolomic assays were performed in human hepatoma cells transfected with lentiviral vectors causing PKLR overexpression and silencing, respectively. We then constructed a molecular network based on integrative analysis of transcriptomic and metabolomic data. We also assessed the biological functions of PKLR in the global metabolome in LT grafts in patients via a weighted correlation network model. Results Multiomic analysis revealed that PKLR perturbations significantly affected the pyruvate, citrate, and glycerophospholipid metabolism pathways, as crucial steps in de novo lipogenesis (DNL). We also confirmed the importance of phosphatidylcholines (PC) and its derivative lyso-PC supply on improved survival of LT grafts in patients. Coexpression analysis revealed beneficial effects of PKLR overexpression on posttransplant prognosis by alleviating arachidonic acid metabolism of the grafts, independent of operational risk factors. Conclusion This systems-level analysis indicated that PKLR affected hepatoma cell viability via impacts on the whole process of DNL, from glycolysis to final PC synthesis. PKLR also improved prognosis after LT, possibly via its impact on the increased genesis of beneficial glycerophospholipids.
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10
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de Vries RJ, Tessier SN, Banik PD, Nagpal S, Cronin SEJ, Ozer S, Hafiz EOA, van Gulik TM, Yarmush ML, Markmann JF, Toner M, Yeh H, Uygun K. Subzero non-frozen preservation of human livers in the supercooled state. Nat Protoc 2020; 15:2024-2040. [PMID: 32433625 DOI: 10.1038/s41596-020-0319-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022]
Abstract
Preservation of human organs at subzero temperatures has been an elusive goal for decades. The major complication hindering successful subzero preservation is the formation of ice at temperatures below freezing. Supercooling, or subzero non-freezing, preservation completely avoids ice formation at subzero temperatures. We previously showed that rat livers can be viably preserved three times longer by supercooling as compared to hypothermic preservation at +4 °C. Scalability of supercooling preservation to human organs was intrinsically limited because of volume-dependent stochastic ice formation at subzero temperatures. However, we recently adapted the rat preservation approach so it could be applied to larger organs. Here, we describe a supercooling protocol that averts freezing of human livers by minimizing air-liquid interfaces as favorable sites of ice nucleation and uses preconditioning with cryoprotective agents to depress the freezing point of the liver tissue. Human livers are homogeneously preconditioned during multiple machine perfusion stages at different temperatures. Including preparation, the protocol takes 31 h to complete. Using this protocol, human livers can be stored free of ice at -4 °C, which substantially extends the ex vivo life of the organ. To our knowledge, this is the first detailed protocol describing how to perform subzero preservation of human organs.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Shannon N Tessier
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Peony D Banik
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Sonal Nagpal
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Stephanie E J Cronin
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Sinan Ozer
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Ehab O A Hafiz
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA.,Department of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin L Yarmush
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - James F Markmann
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Mehmet Toner
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Heidi Yeh
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA. .,Department of Research, Shriners Hospitals for Children-Boston, Boston, MA, USA.
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11
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Raigani S, Carroll C, Griffith S, Pendexter C, Rosales I, Deirawan H, Beydoun R, Yarmush M, Uygun K, Yeh H. Improvement of steatotic rat liver function with a defatting cocktail during ex situ normothermic machine perfusion is not directly related to liver fat content. PLoS One 2020; 15:e0232886. [PMID: 32396553 PMCID: PMC7217452 DOI: 10.1371/journal.pone.0232886] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
There is a significant organ shortage in the field of liver transplantation, partly due to a high discard rate of steatotic livers from donors. These organs are known to function poorly if transplanted but make up a significant portion of the available pool of donated livers. This study demonstrates the ability to improve the function of steatotic rat livers using a combination of ex situ machine perfusion and a "defatting" drug cocktail. After 6 hours of perfusion, defatted livers demonstrated lower perfusate lactate levels and improved bile quality as demonstrated by higher bile bicarbonate and lower bile lactate. Furthermore, defatting was associated with decreased gene expression of pro-inflammatory cytokines and increased expression of enzymes involved in mitochondrial fatty acid oxidation. Rehabilitation of marginal or discarded steatotic livers using machine perfusion and tailored drug therapy can significantly increase the supply of donor livers for transplantation.
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Affiliation(s)
- Siavash Raigani
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Cailah Carroll
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Stephanie Griffith
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Casie Pendexter
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Ivy Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Hany Deirawan
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Rafic Beydoun
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Martin Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, United States of America
| | - Korkut Uygun
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Heidi Yeh
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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12
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Cell release during perfusion reflects cold ischemic injury in rat livers. Sci Rep 2020; 10:1102. [PMID: 31980677 PMCID: PMC6981218 DOI: 10.1038/s41598-020-57589-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/28/2019] [Indexed: 12/13/2022] Open
Abstract
The global shortage of donor organs has made it crucial to deeply understand and better predict donor liver viability. However, biomarkers that effectively assess viability of marginal grafts for organ transplantation are currently lacking. Here, we showed that hepatocytes, sinusoidal endothelial, stellate, and liver-specific immune cells were released into perfusates from Lewis rat livers as a result of cold ischemia and machine perfusion. Perfusate comparison analysis of fresh livers and cold ischemic livers showed that the released cell profiles were significantly altered by the duration of cold ischemia. Our findings show for the first time that parenchymal cells are released from organs under non-proliferative pathological conditions, correlating with the degree of ischemic injury. Thus, perfusate cell profiles could serve as potential biomarkers of graft viability and indicators of specific injury mechanisms during organ handling and transplantation. Further, parenchymal cell release may have applications in other pathological conditions beyond organ transplantation.
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13
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Huang V, Karimian N, Detelich D, Raigani S, Geerts S, Beijert I, Fontan FM, Aburawi MM, Ozer S, Banik P, Lin F, Karabacak M, Hafiz EO, Porte RJ, Uygun K, Markmann JF, Yeh H. Split-Liver Ex Situ Machine Perfusion: A Novel Technique for Studying Organ Preservation and Therapeutic Interventions. J Clin Med 2020; 9:E269. [PMID: 31963739 PMCID: PMC7019984 DOI: 10.3390/jcm9010269] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
Ex situ machine perfusion is a promising technology to help improve organ viability prior to transplantation. However, preclinical studies using discarded human livers to evaluate therapeutic interventions and optimize perfusion conditions are limited by significant graft heterogeneity. In order to improve the efficacy and reproducibility of future studies, a split-liver perfusion model was developed to allow simultaneous perfusion of left and right lobes, allowing one lobe to serve as a control for the other. Eleven discarded livers were surgically split, and both lobes perfused simultaneously on separate perfusion devices for 3 h at subnormothermic temperatures. Lobar perfusion parameters were also compared with whole livers undergoing perfusion. Similar to whole-liver perfusions, each lobe in the split-liver model exhibited a progressive decrease in arterial resistance and lactate levels throughout perfusion, which were not significantly different between right and left lobes. Split liver lobes also demonstrated comparable energy charge ratios. Ex situ split-liver perfusion is a novel experimental model that allows each graft to act as its own control. This model is particularly well suited for preclinical studies by avoiding the need for large numbers of enrolled livers necessary due to the heterogenous nature of discarded human liver research.
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Affiliation(s)
- Viola Huang
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Negin Karimian
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Danielle Detelich
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Siavash Raigani
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Sharon Geerts
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Irene Beijert
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, 9700 Groningen, The Netherlands; (I.B.); (R.J.P.)
| | - Fermin M. Fontan
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Mohamed M. Aburawi
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Sinan Ozer
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Peony Banik
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Florence Lin
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Murat Karabacak
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - Ehab O.A. Hafiz
- Electron Microscopy Department, Theodor Bilharz Research Institute, Giza 12411, Egypt;
| | - Robert J. Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, 9700 Groningen, The Netherlands; (I.B.); (R.J.P.)
| | - Korkut Uygun
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
| | - James F. Markmann
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
| | - Heidi Yeh
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; (V.H.); (N.K.); (D.D.); (S.R.); (F.M.F.); (M.M.A.); (K.U.); (J.F.M.)
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (S.G.); (S.O.); (P.B.); (F.L.); (M.K.)
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14
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Raigani S, De Vries RJ, Uygun K, Yeh H. Pumping new life into old ideas: Preservation and rehabilitation of the liver using ex situ machine perfusion. Artif Organs 2019; 44:123-128. [PMID: 31691326 DOI: 10.1111/aor.13579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
Recent advances in machine perfusion technology have reinvigorated the field of liver transplantation with the possibilities of vastly improving the efficiency and safety of the life-saving procedure. With this improved preservation technology, transplant surgeons are now able to use previously untransplantable donor livers without significantly compromising patient outcomes. Early clinical studies demonstrate the ability to extend preservation times and assess a graft's potential viability using normothermic machine perfusion, in addition to restoring the energy supply in donor livers by supporting metabolism through circulation of vital nutrients and blood-based oxygen carriers. Future endeavors for surgeons and scientists should focus on improving criteria to assess viability, optimizing protocols for perfusion research, investigating mechanisms of poor graft viability, and targeting these mechanisms with novel therapies to improve graft function prior to transplantation. Long-term goals include extending preservation times on the scale of days to weeks, enabling long-distance organ sharing, and establishing regional organ perfusion centers to streamline the procurement, perfusion, and transplantation process.
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Affiliation(s)
- Siavash Raigani
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reinier J De Vries
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Korkut Uygun
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi Yeh
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Lemaire F, Sigrist S, Delpy E, Cherfan J, Peronet C, Zal F, Bouzakri K, Pinget M, Maillard E. Beneficial effects of the novel marine oxygen carrier M101 during cold preservation of rat and human pancreas. J Cell Mol Med 2019; 23:8025-8034. [PMID: 31602751 PMCID: PMC6850937 DOI: 10.1111/jcmm.14666] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 12/27/2022] Open
Abstract
Ischaemia impairs organ quality during preservation in a time‐dependent manner, due to a lack of oxygen supply. Its impact on pancreas and islet transplantation outcome has been demonstrated by a correlation between cold ischaemia time and poor islet isolation efficiency. Our goal in the present study was to improve pancreas and islet quality using a novel natural oxygen carrier (M101, 2 g/L), which has been proven safe and efficient in other clinical applications, including kidney transplantation, and for several pre‐clinical transplantation models. When M101 was added to the preservation solution of rat pancreas during ischaemia, a decrease in oxidative stress (ROS), necrosis (HMGB1), and cellular stress pathway (p38 MAPK)activity was observed. Freshly isolated islets had improved function when M101 was injected in the pancreas. Additionally, human pancreases exposed to M101 for 3 hours had an increase in complex 1 mitochondrial activity, as well as activation of AKT activity, a cell survival marker. Insulin secretion was also up‐regulated for isolated islets. In summary, these results demonstrate a positive effect of the oxygen carrier M101 on rat and human pancreas during preservation, with an overall improvement in post‐isolation islet quality.
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Affiliation(s)
- Florent Lemaire
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Séverine Sigrist
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Eric Delpy
- HEMARINA Aéropôle Centre, Biotechnopôle, Morlaix, France
| | - Julien Cherfan
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Claude Peronet
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Franck Zal
- HEMARINA Aéropôle Centre, Biotechnopôle, Morlaix, France
| | - Karim Bouzakri
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Michel Pinget
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
| | - Elisa Maillard
- UMR DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Strasbourg, France
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16
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de Vries RJ, Tessier SN, Banik PD, Nagpal S, Cronin SEJ, Ozer S, Hafiz EOA, van Gulik TM, Yarmush ML, Markmann JF, Toner M, Yeh H, Uygun K. Supercooling extends preservation time of human livers. Nat Biotechnol 2019; 37:1131-1136. [PMID: 31501557 PMCID: PMC6776681 DOI: 10.1038/s41587-019-0223-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 07/12/2019] [Indexed: 12/25/2022]
Abstract
The inability to preserve vascular organs beyond several hours contributes to the scarcity of organs for transplantation1,2. Standard hypothermic preservation at +4 °C (refs. 1,3) limits liver preservation to less than 12 h. Our group previously showed that supercooled ice-free storage at -6 °C can extend viable preservation of rat livers4,5 However, scaling supercooling preservation to human organs is intrinsically limited because of volume-dependent stochastic ice formation. Here, we describe an improved supercooling protocol that averts freezing of human livers by minimizing favorable sites of ice nucleation and homogeneous preconditioning with protective agents during machine perfusion. We show that human livers can be stored at -4 °C with supercooling followed by subnormothermic machine perfusion, effectively extending the ex vivo life of the organ by 27 h. We show that viability of livers before and after supercooling is unchanged, and that after supercooling livers can withstand the stress of simulated transplantation by ex vivo normothermic reperfusion with blood.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands
- Shriners Hospital for Children, Boston, MA, USA
| | - Shannon N Tessier
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Peony D Banik
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Sonal Nagpal
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Stephanie E J Cronin
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Sinan Ozer
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Ehab O A Hafiz
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
- Department of Electron Microscopy Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Thomas M van Gulik
- Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin L Yarmush
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - James F Markmann
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Mehmet Toner
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children, Boston, MA, USA
| | - Heidi Yeh
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Center for Transplant Sciences, Massachusetts General Hospital, Boston, MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.
- Shriners Hospital for Children, Boston, MA, USA.
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17
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Nostedt JJ, Churchill T, Ghosh S, Thiesen A, Hopkins J, Lees MC, Adam B, Freed DH, Shapiro AMJ, Bigam DL. Avoiding initial hypothermia does not improve liver graft quality in a porcine donation after circulatory death (DCD) model of normothermic perfusion. PLoS One 2019; 14:e0220786. [PMID: 31386697 PMCID: PMC6684160 DOI: 10.1371/journal.pone.0220786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background Normothermic machine perfusion (NMP) of liver grafts donated after circulatory death (DCD) has shown promise in large animal and clinical trials. Following procurement, initial flush with a cold preservation solution is the standard of care. There is concern that initial cooling followed by warming may exacerbate liver injury, and the optimal initial flush temperature has yet to be identified. We hypothesize that avoidance of the initial cold flush will yield better quality liver grafts. Methods Twenty-four anaesthetized pigs were withdrawn from mechanical ventilation and allowed to arrest. After 60-minutes of warm ischemia to simulate a DCD procurement, livers were flushed with histidine-tryptophan-ketoglutarate (HTK) at 4°C, 25°C or 35°C (n = 4 per group). For comparison, an adenosine-lidocaine crystalloid solution (AD), shown to have benefit at warm temperatures in heart perfusions, was also used (n = 4 per group). During 12-hours of NMP, adenosine triphosphate (ATP), lactate, transaminase levels, and histological injury were determined. Bile production and hemodynamics were monitored continuously. Results ATP levels recovered substantially following 1-hour of NMP reaching pre-ischemic levels by the end of NMP with no difference between groups. There was no difference in peak aspartate aminotransferase (AST) or in lactate dehydrogenase (LDH). Portal vein resistance was lowest in the 4°C group reaching significance after 2 hours (0.13 CI -0.01,0.277, p = 0.025). Lactate levels recovered promptly with no difference between groups. Comparison to AD groups showed no statistical difference in the abovementioned parameters. On electron microscopy the HTK4°C group had the least edema with mean cell thickness of 2.92μm (p = 0.41) while also having the least sinusoidal dilatation with a mean diameter of 5.36μm (p = 0.04). For AD, the 25°C group had the lowest mean cell thickness at 3.14μm (p = 0.09). Conclusions Avoidance of the initial cold flush failed to demonstrate added benefit over standard 4°C HTK in this DCD model of liver perfusion.
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Affiliation(s)
- Jordan J. Nostedt
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
- * E-mail: (JJN); (DLB)
| | - Tom Churchill
- Department of Surgery, Division of Surgical Research, University of Alberta, Edmonton AB, Canada
| | - Sunita Ghosh
- Department of Mathematics and Statistical Sciences, University of Alberta, Edmonton AB, Canada
| | - Aducio Thiesen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB, Canada
| | - Jessica Hopkins
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - Mackenzie C. Lees
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB, Canada
| | - Darren H. Freed
- Department of Physiology, University of Alberta, Edmonton AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton AB, Canada
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton AB, Canada
| | - A. M. James Shapiro
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - David L. Bigam
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
- * E-mail: (JJN); (DLB)
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18
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Mahboub P, Aburawi M, Karimian N, Lin F, Karabacak M, Fontan F, Tessier SN, Markmann J, Yeh H, Uygun K. The efficacy of HBOC-201 in ex situ gradual rewarming kidney perfusion in a rat model. Artif Organs 2019; 44:81-90. [PMID: 31368159 PMCID: PMC6916591 DOI: 10.1111/aor.13534] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
Gradual rewarming from hypothermic to normothermic is a novel perfusion modality with superior outcome to sudden rewarming to normothermic. However, the identification of an oxygen carrier that could function at a temperature range from 4 to 7°C or whether it is necessary to use oxygen carrier during kidney rewarming, remains unresolved. This study was designed to test the use of a hemoglobin‐based oxygen carrier (HBOC) during gradual kidney rewarming as an alternative to simple dissolved oxygen. In this study, 10 rat kidneys were randomly divided into the control and the HBOC group. In the control group, no oxygen carrier was used during rewarming perfusion and the perfusion solution was oxygenated only by applying diffused carbogen flow. The protocol mimicked a donor after circulatory death (DCD) kidney transplantation, where after 30 minutes warm ischemia and 120 minutes cold storage in University of Wisconsin solution, the DCD kidneys underwent gradual rewarming from 10 to 37°C during 90 minutes with or without HBOC. This was followed by 30 minutes of warm ischemia in room temperature to mimic the anastomosis time and 120 minutes of reperfusion at 37°C to mimic the early post‐transplant state of the graft. The HBOC group demonstrated superior kidney function which was highlighted by higher ultrafiltrate production, better glomerular filtration rate and improved sodium reabsorption. There was no significant difference between the 2 groups regarding the hemodynamics, tissue injury, and adenosine triphosphate levels. In conclusion, this study suggests better renal function recovery in DCD kidneys after rewarming with HBOC compared to rewarming without an oxygen carrier.
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Affiliation(s)
- Paria Mahboub
- University Medical Center Groningen, Groningen, Netherlands.,Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Aburawi
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Negin Karimian
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Florence Lin
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Murat Karabacak
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fermin Fontan
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shannon N Tessier
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Markmann
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Heidi Yeh
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Korkut Uygun
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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19
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de Vries RJ, Yarmush M, Uygun K. Systems engineering the organ preservation process for transplantation. Curr Opin Biotechnol 2019; 58:192-201. [PMID: 31280087 PMCID: PMC7261508 DOI: 10.1016/j.copbio.2019.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 12/23/2022]
Abstract
Improving organ preservation and extending the preservation time would have game-changing effects on the current practice of organ transplantation. Machine perfusion has emerged as an improved preservation technology to expand the donor pool, assess graft viability and ensure adequate graft function. However, its efficacy in extending the preservation time is limited. Subzero organ preservation does hold the promise to significantly extend the preservation time and recent advances in cryobiology bring it closer to clinical translation. In this review, we aim to broaden the perspective in the field from a focus on these individual technologies to that of a systems engineering. This would enable the creation of a preservation process that integrates the benefits of machine perfusion with those of subzero preservation, with the ultimate goal to provide on demand availability of donor organs through organ banking.
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Affiliation(s)
- Reinier J de Vries
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA; Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA; Department of Biomedical Engineering, Rutgers University, New Brunswick, NJ, USA
| | - Korkut Uygun
- Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children, Boston, MA, USA.
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20
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Affiliation(s)
- Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Korkut Uygun
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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21
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Endothelial Dysfunction in Steatotic Human Donor Livers: A Pilot Study of the Underlying Mechanism During Subnormothermic Machine Perfusion. Transplant Direct 2018; 4:e345. [PMID: 29796416 PMCID: PMC5959347 DOI: 10.1097/txd.0000000000000779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/20/2018] [Indexed: 02/06/2023] Open
Abstract
Supplemental digital content is available in the text. Background Steatosis is a major risk factor for primary nonfunction in liver transplantations. Steatotic livers recover poorly from ischemia reperfusion injury, in part due to alterations in the microcirculation, although the exact mechanism is unclear. In this study, we tested if there were any alterations in the shear stress sensing Kruppel-like factor 2 (KLF2) and its likely downstream consequences in the ex vivo perfused human liver endothelium, which would imply perturbations in microcirculatory flow in macrosteatotic livers disrupts laminar flow to evaluate if this is a potential therapeutic target for steatotic livers. Methods Using a subnormothermic machine perfusion system, 5 macrosteatotic and 4 nonsteatotic human livers were perfused for 3 hours. Flow, resistance, and biochemical profile were monitored. Gene expression levels of nitric oxide synthase 3 (eNOS), KLF2, and thrombomodulin were determined. Nitric oxide (NO) was measured in the perfusion fluid and activation of eNOS was measured with Western blotting. Results Flow dynamics, injury markers, and bile production were similar in both groups. Kruppel-like factor 2 expression was significantly higher in nonsteatotic livers. Western blotting analyses showed significantly higher levels of activated eNOS in nonsteatotic livers, consistent with an increase in NO production over time. Macrosteatotic livers showed decreased KLF2 upregulation, eNOS activity, and NO production during machine perfusion. Conclusions These results indicate a perturbed KLF2 sensing in steatotic livers, which aligns with perturbed microcirculatory state. This may indicate endothelial dysfunction and contribute to poor posttransplantation outcomes in fatty livers, and further studies to confirm by evaluation of flow and testing treatments are warranted.
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