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Serradilla J, Andrés Moreno AM, Talayero P, Burgos P, Machuca M, Camps Ortega O, Vallejo MT, Rubio Bolívar FJ, Bueno A, Sánchez A, Zambrano C, De la Torre Ramos CA, Rodríguez O, Largo C, Serrano P, Prieto Bozano G, Ramos E, López Santamaría M, Stringa P, Hernández F. Preclinical Study of DCD and Normothermic Perfusion for Visceral Transplantation. Transpl Int 2023; 36:11518. [PMID: 37745640 PMCID: PMC10514355 DOI: 10.3389/ti.2023.11518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023]
Abstract
Considering recent clinical and experimental evidence, expectations for using DCD-derived intestines have increased considerably. However, more knowledge about DCD procedure and long-term results after intestinal transplantation (ITx) is needed. We aimed to describe in detail a DCD procedure for ITx using normothermic regional perfusion (NRP) in a preclinical model. Small bowel was obtained from pigs donors after 1 h of NRP and transplanted to the recipients. Graft Intestinal samples were obtained during the procedure and after transplantation. Ischemia-reperfusion injury (Park-Chiu score), graft rejection and transplanted intestines absorptive function were evaluated. Seven of 8 DCD procedures with NRP and ITx were successful (87.5%), with a good graft reperfusion and an excellent recovery of the recipient. The architecture of grafts was well conserved during NRP. After an initial damage of Park-chiu score of 4, all grafts recovered from ischemia-reperfusion, with no or very subtle alterations 2 days after ITx. Most recipients (71.5%) did not show signs of rejection. Only two cases demonstrated histologic signs of mild rejection 7 days after ITx. Interestingly intestinal grafts showed good absorptive capacity. The study's results support the viability of intestinal grafts from DCD using NRP, contributing more evidence for the use of DCD for ITx.
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Affiliation(s)
- Javier Serradilla
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Ane Miren Andrés Moreno
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Paloma Talayero
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Paula Burgos
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Department of Cardiovascular Surgery, La Paz University Hospital, Madrid, Spain
| | - Mariana Machuca
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Argentina
| | - Onys Camps Ortega
- Molecular Imaging and Immunohistochemistry Laboratory, Institute for Health Research IdiPaz, Madrid, Spain
| | - María Teresa Vallejo
- Molecular Imaging and Immunohistochemistry Laboratory, Institute for Health Research IdiPaz, Madrid, Spain
| | | | - Alba Bueno
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Alba Sánchez
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Cristina Zambrano
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Carlos Andrés De la Torre Ramos
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Olaia Rodríguez
- Department of Biochemistry, La Paz University Hospital, IdiPaz, Madrid, Spain
| | - Carlota Largo
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Department of Experimental Surgery, La Paz University Hospital, Madrid, Spain
| | - Pilar Serrano
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Gerardo Prieto Bozano
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Esther Ramos
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Intestinal Rehabilitation and Transplantation Unit, La Paz University Hospital, Madrid, Spain
| | - Manuel López Santamaría
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
| | - Pablo Stringa
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
- Institute for Immunological and Pathophysiological Studies (IIFP), National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Francisco Hernández
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
- Transplant Research Group, Institute for Health Research IdiPaz, Madrid, Spain
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Madrahimov N, Mutsenko V, Natanov R, Radaković D, Klapproth A, Hassan M, Rosenfeldt M, Kleefeldt F, Aleksic I, Ergün S, Otto C, Leyh RG, Bening C. Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model. Intensive Care Med Exp 2023; 11:46. [PMID: 37537415 PMCID: PMC10400742 DOI: 10.1186/s40635-023-00534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Transplant candidates on the waiting list are increasingly challenged by the lack of organs. Most of the organs can only be kept viable within very limited timeframes (e.g., mere 4-6 h for heart and lungs exposed to refrigeration temperatures ex vivo). Donation after circulatory death (DCD) using extracorporeal membrane oxygenation (ECMO) can significantly enlarge the donor pool, organ yield per donor, and shelf life. Nevertheless, clinical attempts to recover organs for transplantation after uncontrolled DCD are extremely complex and hardly reproducible. Therefore, as a preliminary strategy to fulfill this task, experimental protocols using feasible animal models are highly warranted. The primary aim of the study was to develop a model of ECMO-based cadaver organ recovery in mice. Our model mimics uncontrolled organ donation after an "out-of-hospital" sudden unexpected death with subsequent "in-hospital" cadaver management post-mortem. The secondary aim was to assess blood gas parameters, cardiac activity as well as overall organ state. The study protocol included post-mortem heparin-streptokinase administration 10 min after confirmed death induced by cervical dislocation under full anesthesia. After cannulation, veno-arterial ECMO (V-A ECMO) was started 1 h after death and continued for 2 h under mild hypothermic conditions followed by organ harvest. Pressure- and flow-controlled oxygenated blood-based reperfusion of a cadaver body was accompanied by blood gas analysis (BGA), electrocardiography, and histological evaluation of ischemia-reperfusion injury. For the first time, we designed and implemented, a not yet reported, miniaturized murine hemodialysis circuit for the treatment of severe hyperkalemia and metabolic acidosis post-mortem. RESULTS BGA parameters confirmed profound ischemia typical for cadavers and incompatible with normal physiology, including extremely low blood pH, profound negative base excess, and enormously high levels of lactate. Two hours after ECMO implantation, blood pH values of a cadaver body restored from < 6.5 to 7.3 ± 0.05, pCO2 was lowered from > 130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO3 were all elevated from below detection thresholds to 99.5 ± 0.6%, - 4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T test, p < 0.05). A substantial decrease in hyperlactatemia (from > 20 to 10.5 ± 1.7 mmol/L) and hyperkalemia (from > 9 to 6.9 ± 1.0 mmol/L) was observed when hemodialysis was implemented. On balance, the first signs of regained heart activity appeared on average 10 min after ECMO initiation without cardioplegia or any inotropic and vasopressor support. This was followed by restoration of myocardial contractility with a heart rate of up to 200 beats per minute (bpm) as detected by an electrocardiogram (ECG). Histological examinations revealed no evidence of heart injury 3 h post-mortem, whereas shock-specific morphological changes relevant to acute death and consequent cardiac/circulatory arrest were observed in the lungs, liver, and kidney of both control and ECMO-treated cadaver mice. CONCLUSIONS Thus, our model represents a promising approach to facilitate studying perspectives of cadaveric multiorgan recovery for transplantation. Moreover, it opens new possibilities for cadaver organ treatment to extend and potentiate donation and, hence, contribute to solving the organ shortage dilemma.
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Affiliation(s)
- Nodir Madrahimov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Vitalii Mutsenko
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dejan Radaković
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - André Klapproth
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Mohamed Hassan
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Mathias Rosenfeldt
- Institute for Pathology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Florian Kleefeldt
- Institute of Anatomy and Cell Biology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Ivan Aleksic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Christoph Otto
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
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Stringa P, Vecchio Dezillio LE, Talayero P, Serradilla J, Errea A, Machuca M, Papa-Gobbi R, Camps Ortega O, Pucci Molineris M, Lausada N, Andres Moreno AM, Rumbo M, Hernández Oliveros F. Experimental Assessment of Intestinal Damage in Controlled Donation After Circulatory Death for Visceral Transplantation. Transpl Int 2023; 36:10803. [PMID: 36713114 PMCID: PMC9878676 DOI: 10.3389/ti.2023.10803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
There is an urgent need to address the shortage of potential multivisceral grafts in order to reduce the average time in waiting list. Since donation after circulatory death (DCD) has been successfully employed for other solid organs, a thorough evaluation of the use of intestinal grafts from DCD is warranted. Here, we have generated a model of Maastricht III DCD in rodents, focusing on the viability of intestinal and multivisceral grafts at five (DCD5) and twenty (DCD20) minutes of cardiac arrest compared to living and brain death donors. DCD groups exhibited time-dependent damage. DCD20 generated substantial intestinal mucosal injury and decreased number of Goblet cells whereas grafts from DCD5 closely resemble those of brain death and living donors groups in terms intestinal morphology, expression of tight junction proteins and number of Paneth and Globet cells. Upon transplantation, intestines from DCD5 showed increased ischemia/reperfusion damage compared to living donor grafts, however mucosal integrity was recovered 48 h after transplantation. No differences in terms of graft rejection, gene expression and absorptive function between DCD5 and living donor were observed at 7 post-transplant days. Collectively, our results highlight DCD as a possible strategy to increase multivisceral donation and transplantation procedures.
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Affiliation(s)
- Pablo Stringa
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina,Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Leandro Emmanuel Vecchio Dezillio
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina,Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Paloma Talayero
- Immunology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Javier Serradilla
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Agustina Errea
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Mariana Machuca
- Special Pathology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, La Plata, Argentina
| | - Rodrigo Papa-Gobbi
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Onys Camps Ortega
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Melisa Pucci Molineris
- Biochemistry Research Institute of La Plata, School of Medicine, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Natalia Lausada
- Organ Transplant Laboratory, School of Medicine, National University of La Plata, La Plata, Argentina
| | - Ane Miren Andres Moreno
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Martin Rumbo
- Institute for Immunological and Pathophysiological Studies (IIFP), School of Exact Sciences, National University of La Plata, National Council of Scientific and Technical Research (CONICET), La Plata, Argentina
| | - Francisco Hernández Oliveros
- Transplant Group, La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain,Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain,Executive Operational Committee, ERN TransplantChild, Madrid, Spain,*Correspondence: Francisco Hernández Oliveros,
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Winiszewski H, Guinot PG, Schmidt M, Besch G, Piton G, Perrotti A, Lorusso R, Kimmoun A, Capellier G. Optimizing PO 2 during peripheral veno-arterial ECMO: a narrative review. Crit Care 2022; 26:226. [PMID: 35883117 PMCID: PMC9316319 DOI: 10.1186/s13054-022-04102-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
During refractory cardiogenic shock and cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to restore a circulatory output. However, it also impacts significantly arterial oxygenation. Recent guidelines of the Extracorporeal Life Support Organization (ELSO) recommend targeting postoxygenator partial pressure of oxygen (PPOSTO2) around 150 mmHg. In this narrative review, we intend to summarize the rationale and evidence for this PPOSTO2 target recommendation. Because this is the most used configuration, we focus on peripheral VA-ECMO. To date, clinicians do not know how to set the sweep gas oxygen fraction (FSO2). Because of the oxygenator's performance, arterial hyperoxemia is common during VA-ECMO support. Interpretation of oxygenation is complex in this setting because of the dual circulation phenomenon, depending on both the native cardiac output and the VA-ECMO blood flow. Such dual circulation results in dual oxygenation, with heterogeneous oxygen partial pressure (PO2) along the aorta, and heterogeneous oxygenation between organs, depending on the mixing zone location. Data regarding oxygenation during VA-ECMO are scarce, but several observational studies have reported an association between hyperoxemia and mortality, especially after refractory cardiac arrest. While hyperoxemia should be avoided, there are also more and more studies in non-ECMO patients suggesting the harm of a too restrictive oxygenation strategy. Finally, setting FSO2 to target strict normoxemia is challenging because continuous monitoring of postoxygenator oxygen saturation is not widely available. The threshold of PPOSTO2 around 150 mmHg is supported by limited evidence but aims at respecting a safe margin, avoiding both hypoxemia and severe hyperoxemia.
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Affiliation(s)
- Hadrien Winiszewski
- Service de Réanimation Médicale, centre hospitalier universitaire de Besançon, Besançon, France. .,Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France.
| | - Pierre-Grégoire Guinot
- Service d'Anesthésie-Réanimation Chirurgicale, centre hospitalier universitaire de Dijon, Dijon, France
| | - Matthieu Schmidt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Besch
- Service d'Anesthésie-Réanimation Chirurgicale, centre hospitalier universitaire de Besançon, Besançon, France.,Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France
| | - Gael Piton
- Service de Réanimation Médicale, centre hospitalier universitaire de Besançon, Besançon, France.,Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France
| | - Andrea Perrotti
- Service de Chirurgie Cardiaque, centre hospitalier universitaire de Besançon, Besançon, France.,Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antoine Kimmoun
- Service de Médecine Intensive Réanimation, centre hospitalier universitaire de Nancy Brabois, Vandœuvre-lès-Nancy, France
| | - Gilles Capellier
- Service de Réanimation Médicale, centre hospitalier universitaire de Besançon, Besançon, France.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia.,Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besancon, France
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Clarysse M, Dubois A, Vanuytsel T, Pirenne J, Ceulemans LJ. Potential options to expand the intestinal donor pool: a comprehensive review. Curr Opin Organ Transplant 2022; 27:106-111. [PMID: 35191400 DOI: 10.1097/mot.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intestinal donation is currently restricted to 'perfect' donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated. RECENT FINDINGS Increasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient. SUMMARY Several potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.
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Affiliation(s)
- Mathias Clarysse
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
| | - Antoine Dubois
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Experimental Surgery and Transplantation (CHEX), University Hospital Saint-Luc, Brussels
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Gastroenterology and Hepatology, University Hospitals Leuven & Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA)
| | - Jacques Pirenne
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven & Department of Microbiology, Immunology and Transplantation, KU Leuven
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation (LIFT), University Hospitals Leuven, Leuven
- Department of Thoracic Surgery, University Hospitals Leuven & Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Marchiori G, Berni M, Cassiolas G, Vivarelli L, Lopomo NF, Fini M, Dallari D, Govoni M. Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts? MEMBRANES 2021; 11:membranes11070545. [PMID: 34357195 PMCID: PMC8307999 DOI: 10.3390/membranes11070545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/16/2023]
Abstract
Several studies demonstrated the efficacy of post-mortem extracorporeal membrane oxygenation (ECMO) on donors in preserving organ function addressing organ transplantation. Nevertheless, no common and shared evidence was reached about the possibility of using ECMO donors in tissue harvesting. Therefore, this work aimed first to review the current scientific literature about ECMO donors, and then to focus on the use of ECMO tissues as allografts, mainly addressing musculoskeletal tissues, which are of the most interest for reconstruction. A search was conducted on the current scientific literature, focusing on the keywords "ECMO" and "Donor". Several online databases were used, including PubMed, Scopus, and Web of Science. From the preliminary search, 478 articles were obtained, out of which 173 specifically reported the use of ECMO for donation and transplantation purposes. Literature reported extensive analyses of ECMO organs-overall from the abdomen-both in pre- and post-transplantation studies. On the other hand, ECMO tissues were explanted only in a very limited number of cases; moreover, no information was referred about their status and use. A revision of the current scientific literature highlighted the lack of information concerning ECMO tissues and the necessity to perform preclinical, ex vivo studies to compare allografts from ECMO donors, with respect to standard donors, and, thus, to verify whether they can be harvested and implanted safely and with efficacy.
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Affiliation(s)
- Gregorio Marchiori
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Matteo Berni
- Medical Technology Laboratory Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Giorgio Cassiolas
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
- Correspondence:
| | - Nicola Francesco Lopomo
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
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7
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Heinsar S, Rozencwajg S, Suen J, Bassi GL, Malfertheiner M, Vercaemst L, Broman LM, Schmidt M, Combes A, Rätsep I, Fraser JF, Millar JE. Heart failure supported by veno-arterial extracorporeal membrane oxygenation (ECMO): a systematic review of pre-clinical models. Intensive Care Med Exp 2020; 8:16. [PMID: 32451698 PMCID: PMC7248156 DOI: 10.1186/s40635-020-00303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to treat patients with refractory severe heart failure. Large animal models are developed to help understand physiology and build translational research projects. In order to better understand those experimental models, we conducted a systematic literature review of animal models combining heart failure and VA-ECMO. STUDIES SELECTION A systematic review was performed using Medline via PubMed, EMBASE, and Web of Science, from January 1996 to January 2019. Animal models combining experimental acute heart failure and ECMO were included. Clinical studies, abstracts, and studies not employing VA-ECMO were excluded. DATA EXTRACTION Following variables were extracted, relating to four key features: (1) study design, (2) animals and their peri-experimental care, (3) heart failure models and characteristics, and (4) ECMO characteristics and management. RESULTS Nineteen models of heart failure and VA-ECMO were included in this review. All were performed in large animals, the majority (n = 13) in pigs. Acute myocardial infarction (n = 11) with left anterior descending coronary ligation (n = 9) was the commonest mean of inducing heart failure. Most models employed peripheral VA-ECMO (n = 14) with limited reporting. CONCLUSION Among models that combined severe heart failure and VA-ECMO, there is a large heterogeneity in both design and reporting, as well as methods employed for heart failure. There is a need for standardization of reporting and minimum dataset to ensure translational research achieve high-quality standards.
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Affiliation(s)
- Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia. .,Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Maximilian Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Louven, Belgium
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Matthieu Schmidt
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Alain Combes
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Indrek Rätsep
- Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
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8
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Guo M, Lu C, Li L, Yao D, Li Y. Normothermic extracorporeal membrane oxygenation support: Improving the function of intestinal grafts obtained from cardiac death donors. Artif Organs 2020; 44:1098-1106. [PMID: 32279328 DOI: 10.1111/aor.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/26/2020] [Accepted: 03/28/2020] [Indexed: 12/01/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) could ameliorate the energy status and viability of bowel grafts from cardiac death donors. However, the function of these grafts after transplantation is not clear. The purpose of the study was to evaluate the early function of intestinal grafts after transplantation from expected cardiac death donors supported with normothermic extracorporeal support using a porcine allogeneic orthotopic segmental small bowel transplantation model. Eighteen domestic crossbred donor pigs were assigned to living donation (LD), donation after cardiac death (DCD), and ECMO groups. In the LD group, small bowels were harvested and preserved immediately in cold storage. In the other two groups, the donor pigs received conventional rapid recovery treatment or 1-hour normothermic extracorporeal support after 10-minutes expected cardiac arrest. Subsequently, the small bowels were removed and preserved in cold storage. After 5-6 hours of preservation, small bowel grafts were transplanted into the recipient pigs that underwent enterectomy. The pathology and electron microscopy results, cell apoptosis rate, tight junction protein expression level in the intestinal mucosa, and plasma endotoxin level were evaluated after transplantation. All grafts functioned on the basis of the maltose absorption test results at day 7 after transplantation. There were no significant differences in the morphological changes in the intestinal mucosa among the three groups at day 7 after transplantation. The cell apoptosis rate and plasma endotoxin level in the ECMO group did not differ significantly than those in the LD group, but were evidently lower than those in the DCD group (P < .001). The intestinal absorptive function improved significantly in the ECMO group in contrast with that in the DCD group (P < .001). Short-term ECMO intervention can alleviate ischemia-reperfusion injuries in intestinal grafts and improve intestinal absorptive function in the early stage after transplantation. Reducing caspase-3 protein expression and cell apoptosis in the intestinal mucosa may be one of the protective mechanisms of ECMO intervention.
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Affiliation(s)
- Mingxiao Guo
- Department of General Surgery, Linyi People's Hospital, Linyi, China
| | - Chunlei Lu
- Department of General Surgery, Linyi People's Hospital, Linyi, China
| | - Linlin Li
- Department of Surgery, Linyi Municipal Mental Health Center, Linyi, China
| | - Danhua Yao
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yousheng Li
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Abstract
In this Editor's Review, articles published in 2016 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Mechanical Circulatory Support, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We were pleased to publish our second Virtual Issue in April 2016 on "Tissue Engineering in Bone" by Professor Tsuyoshi Takato. Our first was published in 2011 titled "Intra-Aortic Balloon Pumping" by Dr. Ashraf Khir. Other peer-reviewed Special Issues this year included contributions from the 11th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Ündar and selections from the 23rd Congress of the International Society for Rotary Blood Pumps edited by Dr. Bojan Biocina. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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