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Hasjim BJ, Sanders JM, Alexander M, Redfield RR, Ichii H. Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2024; 13:642. [PMID: 38929081 PMCID: PMC11200710 DOI: 10.3390/antiox13060642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
The limited supply and rising demand for kidney transplantation has led to the use of allografts more susceptible to ischemic reperfusion injury (IRI) and oxidative stress to expand the donor pool. Organ preservation and procurement techniques, such as machine perfusion (MP) and normothermic regional perfusion (NRP), have been developed to preserve allograft function, though their long-term outcomes have been more challenging to investigate. We performed a systematic review and meta-analysis to examine the benefits of MP and NRP compared to traditional preservation techniques. PubMed (MEDLINE), Embase, Cochrane, and Scopus databases were queried, and of 13,794 articles identified, 54 manuscripts were included (n = 41 MP; n = 13 NRP). MP decreased the rates of 12-month graft failure (OR 0.67; 95%CI 0.55, 0.80) and other perioperative outcomes such as delayed graft function (OR 0.65; 95%CI 0.54, 0.79), primary nonfunction (OR 0.63; 95%CI 0.44, 0.90), and hospital length of stay (15.5 days vs. 18.4 days) compared to static cold storage. NRP reduced the rates of acute rejection (OR 0.48; 95%CI 0.35, 0.67) compared to in situ perfusion. Overall, MP and NRP are effective techniques to mitigate IRI and play an important role in safely expanding the donor pool to satisfy the increasing demands of kidney transplantation.
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Affiliation(s)
- Bima J. Hasjim
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Jes M. Sanders
- Department of Surgery, Division of Transplantation, Northwestern Memorial Hospital, Chicago, IL 60611, USA;
| | - Michael Alexander
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Robert R. Redfield
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
| | - Hirohito Ichii
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California–Irvine, Orange, CA 92868, USA; (B.J.H.); (M.A.)
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Werenski H, Stratta RJ, Sharda B, Garner M, Farney AC, Orlando G, McCracken E, Jay CL. Knowing When to Ignore the Numbers: Single-Center Experience Transplanting Deceased Donor Kidneys with Poor Perfusion Parameters. J Am Coll Surg 2023; 236:848-857. [PMID: 36735482 DOI: 10.1097/xcs.0000000000000611] [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: 02/04/2023]
Abstract
BACKGROUND Hypothermic machine perfusion is frequently used in evaluating marginal kidneys with poor perfusion parameters (PPP) contributing to delays in kidney placement or discard. We examined outcomes in deceased donor kidney transplants with PPP compared with those with optimal perfusion parameters (OPP). STUDY DESIGN We conducted a retrospective single-center cohort study from 2001 to 2021 comparing PPP (n = 91) with OPP (n = 598) deceased donor kidney transplants. PPP was defined as terminal flow ≤80 mL/min and terminal resistance ≥0.40 mmHg/mL/min. OPP was defined as terminal flow ≥120 mL/min and terminal resistance ≤0.20 mmHg/mL/min. RESULTS Mean terminal flow was PPP 66 ± 16 vs OPP 149 ± 21 mL/min and resistance was PPP 0.47 ± 0.10 vs OPP 0.15 ± 0.04 mmHg/mL/min (both p < 0.001). Donor age, donation after cardiac death, and terminal serum creatinine levels were similar between groups. Mean Kidney Donor Profile Index was higher among PPP donors (PPP 65 ± 23% vs OPP 52 ± 27%, p < 0.001). The PPP transplant group had more females and lower weight and BMI. Delayed graft function was comparable (PPP 32% vs OPP 27%, p = 0.33) even though cold ischemia times trended toward longer in PPP kidneys (PPP 28 ± 10 vs OPP 26 ± 9 hours, p = 0.09). One-year patient survival (PPP 98% vs OPP 97%, p = 0.84) and graft survival (PPP 91% vs OPP 92%, p = 0.23) were equivalent. PPP did predict inferior overall and death-censored graft survival long-term (overall hazard ratio 1.63, 95% CI 1.19 to 2.23 and death-censored hazard ratio 1.77, 95% CI 1.15 to 2.74). At 1 year, the estimated glomerular filtration rate was higher with OPP kidneys (PPP 40 ± 17 vs OPP 52 ± 19 mL/min/1.73 m 2 , p < 0.001). CONCLUSIONS Short-term outcomes in PPP kidneys were comparable to OPP kidneys despite higher Kidney Donor Profile Index and longer cold ischemia times, suggesting a role for increased utilization of these organs with careful recipient selection.
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Affiliation(s)
- Hope Werenski
- From the Department of Surgery, Section of Abdominal Organ Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, NC
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The Challenges of O 2 Detection in Biological Fluids: Classical Methods and Translation to Clinical Applications. Int J Mol Sci 2022; 23:ijms232415971. [PMID: 36555613 PMCID: PMC9786805 DOI: 10.3390/ijms232415971] [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: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Dissolved oxygen (DO) is deeply involved in preserving the life of cellular tissues and human beings due to its key role in cellular metabolism: its alterations may reflect important pathophysiological conditions. DO levels are measured to identify pathological conditions, explain pathophysiological mechanisms, and monitor the efficacy of therapeutic approaches. This is particularly relevant when the measurements are performed in vivo but also in contexts where a variety of biological and synthetic media are used, such as ex vivo organ perfusion. A reliable measurement of medium oxygenation ensures a high-quality process. It is crucial to provide a high-accuracy, real-time method for DO quantification, which could be robust towards different medium compositions and temperatures. In fact, biological fluids and synthetic clinical fluids represent a challenging environment where DO interacts with various compounds and can change continuously and dynamically, and further precaution is needed to obtain reliable results. This study aims to present and discuss the main oxygen detection and quantification methods, focusing on the technical needs for their translation to clinical practice. Firstly, we resumed all the main methodologies and advancements concerning dissolved oxygen determination. After identifying the main groups of all the available techniques for DO sensing based on their mechanisms and applicability, we focused on transferring the most promising approaches to a clinical in vivo/ex vivo setting.
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Kruszyna T, Richter P. Hypothermic Machine Perfusion of Kidneys Compensates for Extended Storage Time: A Single Intervention With a Significant Impact. Transplant Proc 2021; 53:1085-1090. [PMID: 33579549 DOI: 10.1016/j.transproceed.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/17/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Delayed graft function (DGF) adversely affects graft survival and function. Machine perfusion (MP) improves DGF rate and may compensate for extended storage time. MATERIAL AND METHODS In this single-center cohort study, we included 193 consecutive kidney transplantations. MP was used in 78 kidneys (36%) and static cold storage (CS) in 115 kidneys (64%). CS kidneys were transplanted first followed by MP kidneys if stored differently. Pairs of kidneys from the same donor were subjected for subgroup analysis and included 58 pairs. The primary endpoints were the rate of DGF and 1- and 5-year graft survival. The secondary endpoints were the rate of the primary nonfunction, mortality, acute rejection, duration of DGF, and 5-year estimated glomerular filtration rate. RESULTS Median cold ischemia time (CIT) was significantly different between the MP and CS groups (24 vs 20 hours, P < .05). MP significantly reduced the rate of DGF (MP vs CS: 21.8% vs 42.6%, P < .05, odds ratio 0.34, 95% confidence interval 0.17-0.67) with no impact on overall 1- and 5-year survival rates. Storage method did not affect the duration of DGF, mortality rate, acute rejection, or the 5-year estimated glomerular filtration rate. CONCLUSIONS Hypothermic pulsatile MP significantly reduced the rate of DGF in kidneys transplanted with CIT equal to or longer than 12 hours. It is safe and may compensate for longer storage time.
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Affiliation(s)
- Tomasz Kruszyna
- Department of General, Oncological, Gastroenterological Surgery and Transplantation, University Hospital in Krakow, Poland.
| | - Piotr Richter
- Department of General, Oncological, Gastroenterological Surgery and Transplantation, University Hospital in Krakow, Poland
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Horn C, Paul A, Minor T. Low‐pressure machine perfusion of the kidney: role of colloidal support. Transpl Int 2020; 33:465-466. [DOI: 10.1111/tri.13579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Charlotte Horn
- Department for Surgical Research University Hospital Essen Essen Germany
| | - Andreas Paul
- General Visceral and Transplantation Surgery University Hospital Essen Germany
| | - Thomas Minor
- Department for Surgical Research University Hospital Essen Essen Germany
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Samoylova ML, Nash A, Kuchibhatla M, Barbas AS, Brennan TV. Machine perfusion of donor kidneys may reduce graft rejection. Clin Transplant 2019; 33:e13716. [DOI: 10.1111/ctr.13716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amanda Nash
- Department of Surgery Duke University Medical Center Durham North Carolina
| | | | - Andrew S. Barbas
- Department of Surgery Duke University Medical Center Durham North Carolina
| | - Todd V. Brennan
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
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Wszola M, Domagala P, Serwanska-Swietek M, Ostaszewska A, Perkowska-Ptasinska A, Piatek T, Gozdowska J, Durlik M, Chmura A, Kwiatkowski A. Should Immunosuppression After Kidney Transplant Be Adjusted Based on Renal Resistance During Pretransplant Hypothermic Machine Perfusion? Transplant Proc 2019; 51:2676-2682. [PMID: 31477422 DOI: 10.1016/j.transproceed.2019.01.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The hypothermic machine perfusion reduces delayed graft function after kidney transplant and allows, to some extent, predicting early graft function. However, it is difficult to identify exact perfusion criteria with which to exclude kidneys from transplant or modify post-transplant care. The aim of this study was to analyze whether renal resistance during the fourth hour of hypothermic machine perfusion is useful in the prediction of graft survival and acute rejection. PATIENTS AND METHODS Data on pretransplant hypothermic machine perfusion parameters of 407 transplanted kidneys were available. Receiver operating characteristic curve analysis was performed to find an optimal cutoff value of ratio for predicting a higher risk class of considered group of patients. According to this, patients were divided into 2 groups: those who received kidneys with renal resistance lower than 0.19 mm Hg/mL/min (R1; n = 187) and those who received kidneys with renal resistance equal to or higher than 0.19 mm Hg/mL/min (R2; n = 220). Within R2, we additionally analyzed 2 subgroups: patients who received induction therapy (R2-Ind+; n = 124) and those who did not received induction therapy (R2-Ind-; n = 96). RESULTS Acute rejection in R1 within 1 month post transplant was 2-fold lower compared with R2 and was 6.4% vs 13.1% (P = .03), respectively. One-year graft survival was higher in R1 compared with R2 and was 94.6% vs 88.5% (P = .03), respectively. Acute rejection in the R2-Ind+ subgroup within 1 month post transplant was 2.46-fold lower compared with the R2-Ind- subgroup and was 8% vs 19.7% (P = .01), respectively. CONCLUSION Immunosuppression treatment after transplant should be adjusted to perfusion parameters.
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Affiliation(s)
- Michal Wszola
- Foundation of Research and Science Development, Otwock, Poland
| | - Piotr Domagala
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland.
| | | | - Agata Ostaszewska
- Foundation of Research and Science Development, Otwock, Poland; Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | | | - Tomasz Piatek
- Department of Surgical & Transplant Nursing, Medical University of Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplant Medicine and Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine and Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Andrzej Chmura
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Artur Kwiatkowski
- Foundation of Research and Science Development, Otwock, Poland; Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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Wszola M, Domagala P, Ostaszewska A, Gorski L, Karpeta E, Berman A, Sobol M, Durlik M, Chmura A, Kwiatkowski A. Time of Cold Storage Prior to Start of Hypothermic Machine Perfusion and Its Influence on Graft Survival. Transplant Proc 2019; 51:2514-2519. [PMID: 31473005 DOI: 10.1016/j.transproceed.2019.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/22/2019] [Accepted: 02/06/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) has become a standard method of preservation for kidneys procured from expanded-criteria donors and donors after cardiac death. There are different systems and approaches to the HMP preservation period, with cold storage prior to HMP sometimes taking several hours. This study evaluated whether the time at which kidneys receive HMP had any influence on the outcomes of kidney transplantation. METHODS In this analysis, patient and graft survival were evaluated over a 1-year post-transplantation period. Patients who received HMP kidneys (n = 379) were divided into 2 groups: those who received kidneys with a cold ischemia time (CIT) prior to HMP <295 minutes (group G1; n = 254) and those who received kidneys with CIT prior to HMP >295 minutes (group G2; n = 125). RESULTS Delayed graft function was observed in 31.8% (81/254) of patients in group G1 vs 46.4% (58/125) of patients in group G2 (P = .007). One-year graft survival was statistically higher in the group G1 (93.2%; 233/254) vs group G2 (86.5%; 105/125, P = .029). Mean 1-year estimated glomerular filtration rate was significantly better in the group G1. CONCLUSIONS In conclusion, introduction of HMP up to 295 minutes from procurement led to better early and 1-year graft results. Kidneys should receive HMP as soon as possible after retrieval, preferably during procurement.
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Affiliation(s)
- Michal Wszola
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
| | - Piotr Domagala
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland.
| | - Agata Ostaszewska
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
| | - Lukasz Gorski
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
| | - Edyta Karpeta
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland
| | - Andrzej Berman
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
| | - Maria Sobol
- Department of Biophysics and Human Physiology, The Medical University of Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, The Medical University of Warsaw, Poland
| | - Andrzej Chmura
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland
| | - Artur Kwiatkowski
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
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Korayem IM, Agopian VG, Lunsford KE, Gritsch HA, Veale JL, Lipshutz GS, Yersiz H, Serrone CL, Kaldas FM, Farmer DG, Bunnapradist S, Danovitch GM, Busuttil RW, Zarrinpar A. Factors predicting kidney delayed graft function among recipients of simultaneous liver-kidney transplantation: A single-center experience. Clin Transplant 2019; 33:e13569. [PMID: 31006141 DOI: 10.1111/ctr.13569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Kidney delayed graft function (kDGF) remains a challenging problem following simultaneous liver and kidney transplantation (SLKT) with a reported incidence up to 40%. Given the scarcity of renal allografts, it is crucial to minimize the development of kDGF among SLKT recipients to improve patient and graft outcomes. We sought to assess the role of preoperative recipient and donor/graft factors on developing kDGF among recipients of SLKT. METHODS A retrospective review of 194 patients who received SLKT in the period from January 2004 to March 2017 in a single center was performed to assess the effect of preoperative factors on the development of kDGF. RESULTS Kidney delayed graft function was observed in 95 patients (49%). Multivariate analysis revealed that donor history of hypertension, cold static preservation of kidney grafts [versus using hypothermic pulsatile machine perfusion (HPMP)], donor final creatinine, physiologic MELD, and duration of delay of kidney transplantation after liver transplantation were significant independent predictors for kDGF. kDGF is associated with worse graft function and patient and graft survival. CONCLUSIONS Kidney delayed graft function has detrimental effects on graft function and graft survival. Understanding the risks and combining careful perioperative patient management, proper recipient selection and donor matching, and graft preservation using HPMP would decrease kDGF among SLKT recipients.
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Affiliation(s)
- Islam M Korayem
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Surgery, Hepato-Pancreato-Biliary and Liver Transplantation Surgery Unit, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Vatche G Agopian
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Keri E Lunsford
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, J.C. Walter Jr Transplant Center, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas
| | - Hans A Gritsch
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jeffrey L Veale
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gerald S Lipshutz
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Hasan Yersiz
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Coney L Serrone
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fady M Kaldas
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Douglas G Farmer
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Suphamai Bunnapradist
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gabriel M Danovitch
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ronald W Busuttil
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ali Zarrinpar
- Division of Transplantation and Hepatobiliary Surgery, University of Florida, Gainesville, Florida
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Yoshikawa R, Matsuno N, Morito N, Gouchi M, Otani M, Takahashi H, Shonaka T, Nishikawa Y, Enosawa S, Hirano T, Furukawa H, Obara H. Evaluation Using an Isolated Reperfusion Model for Porcine Liver Donated After Cardiac Death Preserved with Oxygenated Hypothermic Machine Perfusion. Ann Transplant 2018; 23:822-827. [PMID: 30478252 PMCID: PMC6284356 DOI: 10.12659/aot.910008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/29/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Machine perfusion techniques offer a solution to the serious organ shortage. However, to assess the effects of machine perfusion, many detailed studies are required. In this study, an ex vivo reperfusion model using diluted autologous blood was confirmed to evaluate the utility of machine preservation for livers donated after cardiac death (DCD). In particular, beneficial effects of the oxygenated hypothermic machine perfusion (HMP) for DCD porcine livers are evaluated. MATERIAL AND METHODS Porcine livers were procured under warm ischemia time (WIT) of 60 min. The livers were preserved by hypothermic machine perfusion (HMP) or static cold storage (CS) for 4 h. After the preservation, the livers were perfused for 2 h using the ex vivo reperfusion model with diluted blood oxygenated by a membrane oxygenator at 35-38°C. RESULTS At 2 h of ex vivo reperfusion with 60 min of warm ischemic time (WIT), the portal vein pressure for CS was higher than HMP (18.8±15.9 vs. 7.5±3.9 [mmHg] in 60 min). Furthermore, LDH in CS was higher than HMP (528.5±149.8 vs. 194.1±32.2 [IU/L/100 g liver] in 60 min. P<0.05). Lactate after CS (60) was significantly higher than HMP (60) (8.67±0.39 vs. 5.68±0.60 [mmol/L] at 60 min. p<0.01). CONCLUSIONS The ex vivo reperfusion model can be used to evaluate the utility of machine perfusion. Advantages of HMP for DCD livers are evaluated with this model.
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Affiliation(s)
- Ryo Yoshikawa
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Naoto Matsuno
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Noriyuki Morito
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Mikako Gouchi
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Masahide Otani
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroyuki Takahashi
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tatsuya Shonaka
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuji Nishikawa
- Department of Pathology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Shin Enosawa
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromichi Obara
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
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Advancing Transplantation: New Questions, New Possibilities in Kidney and Liver Transplantation. Transplantation 2018; 101 Suppl 2S:S1-S41. [PMID: 28125449 DOI: 10.1097/tp.0000000000001563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Zhong Z, Lan J, Ye S, Liu Z, Fan L, Zhang Y, Fu Z, Qiao B, Shiu-Chung Ko D, Wang Y, Ye Q. Outcome Improvement for Hypothermic Machine Perfusion Versus Cold Storage for Kidneys From Cardiac Death Donors. Artif Organs 2018; 41:647-653. [PMID: 28703374 DOI: 10.1111/aor.12828] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/09/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
Organ shortage has led to an increased use of kidneys from cardiac death donors (DCDs), but controversies about the methods of organ preservation still exist. This study aims to compare the effect of machine perfusion (MP) and cold storage (CS) in protecting kidneys harvested from DCDs. 141 kidney pairs from DCDs between July 2010 and July 2015 were included in this randomized controlled study. One kidney from each donor was randomly assigned to MP and the contralateral kidney was assigned to CS. Delayed graft function (DGF) rate, resistance index of renal arteries, early renal function, and survival rates were used to estimate the effect of preservation. The results showed that MP decreased the rate of DGF from 33.3 to 22.0% (P = 0.033). Ultrasound of the kidneys within 48 h after transplantation showed that the resistance index of renal main artery (0.673 ± 0.063 vs. 0.793 ± 0.124, P < 0.001), sub segmental artery (0.66 ± 0.062 vs. 0.764 ± 0.077, P < 0.001) and interlobular artery (0.648 ± 0.056 vs. 0.745 ± 0.111, P = 0.023) were all significantly lower in the MP group than those in the CS group. Furthermore, compared to the CS group, in the first 7 days following transplantation, the median urine volume was significantly higher (4080 mL vs. 3000 mL, P = 0.047) in kidneys sustained using MP and the median serum creatinine was remarkably lower (180 µmol/L vs. 390 µmol/L, P = 0.024). More importantly, MP group had higher 1- and 3-year graft survival rates (98% vs. 93%, P = 0.026; 93% vs. 82%, P = 0.036, respectively). Hypothermic MP improved the outcomes of DCD kidney transplantation.
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Affiliation(s)
- Zibiao Zhong
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Jia'nan Lan
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Shaojun Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Zhongzhong Liu
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Lin Fan
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Yang Zhang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei.,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Fu
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei.,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University, Changsha, China
| | - Bingbing Qiao
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Dicken Shiu-Chung Ko
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Yanfeng Wang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei
| | - Qifa Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei.,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University, Changsha, China
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13
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Quillin RC, Guarrera JV. Hypothermic machine perfusion in liver transplantation. Liver Transpl 2018; 24:276-281. [PMID: 29278454 DOI: 10.1002/lt.25004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
A finite supply of donor organs has led many transplant centers to accept marginal liver allografts with increasing frequency. These allografts may be at higher risk of primary nonfunction, early allograft dysfunction, and other recipient complications following liver transplantation. Machine perfusion preservation is an emerging technology that limits ischemia/reperfusion injury associated with preservation and may lead to improved outcomes following transplantation. Increased used of machine perfusion in liver preservation may permit an expansion of the donor pool. In this review, we examine the major clinical experience of hypothermic machine perfusion in human liver transplantation.Liver Transplantation 24 276-281 2018 AASLD.
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Affiliation(s)
- R Cutler Quillin
- From the Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY
| | - James V Guarrera
- From the Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY
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14
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Matos ACC, Requiao Moura LR, Borrelli M, Nogueira M, Clarizia G, Ongaro P, Durão MS, Pacheco-Silva A. Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge. Clin Transplant 2017; 32. [PMID: 28972665 DOI: 10.1111/ctr.13130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 11/30/2022]
Abstract
Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.
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Affiliation(s)
- Ana Cristina C Matos
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Milton Borrelli
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mario Nogueira
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gabriela Clarizia
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paula Ongaro
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelino Souza Durão
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Medicine/Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplantation Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Medicine/Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
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15
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Diuwe P, Domagala P, Durlik M, Trzebicki J, Chmura A, Kwiatkowski A. The effect of the use of a TNF-alpha inhibitor in hypothermic machine perfusion on kidney function after transplantation. Contemp Clin Trials 2017; 59:44-50. [DOI: 10.1016/j.cct.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 01/08/2023]
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16
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Shen F, Yan R. Design and Implementation of a Hypothermic Machine Perfusion Device for Clinical Preservation of Isolated Organs. SENSORS (BASEL, SWITZERLAND) 2017; 17:E1256. [PMID: 28587173 PMCID: PMC5492428 DOI: 10.3390/s17061256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
The imbalance between limited organ supply and huge potential need has hindered the development of organ-graft techniques. In this paper a low-cost hypothermic machine perfusion (HMP) device is designed and implemented to maintain suitable preservation surroundings and extend the survival life of isolated organs. Four necessary elements (the machine perfusion, the physiological parameter monitoring, the thermostatic control and the oxygenation apparatus) involved in this HMP device are introduced. Especially during the thermostatic control process, a modified Bayes estimation, which introduces the concept of improvement factor, is realized to recognize and reduce the possible measurement errors resulting from sensor faults and noise interference. Also, a fuzzy-PID controller contributes to improve the accuracy and reduces the computational load using the DSP. Our experiments indicate that the reliability of the instrument meets the design requirements, thus being appealing for potential clinical preservation applications.
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Affiliation(s)
- Fei Shen
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China.
| | - Ruqiang Yan
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China.
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17
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Liu Z, Zhong Z, Lan J, Li M, Wang W, Yang J, Tang C, Wang J, Ye S, Xiong Y, Wang Y, Ye Q. Mechanisms of Hypothermic Machine Perfusion to Decrease Donation After Cardiac Death Graft Inflammation: Through the Pathway of Upregulating Expression of KLF2 and Inhibiting TGF-β Signaling. Artif Organs 2017; 41:82-88. [DOI: 10.1111/aor.12701] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Zhongzhong Liu
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Zibiao Zhong
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Jianan Lan
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Mingxia Li
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Wei Wang
- Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University; Changsha China
| | - Jing Yang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Chenwei Tang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Jie Wang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Shaojun Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Yan Xiong
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Yanfeng Wang
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
| | - Qifa Ye
- Wuhan University, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation; Wuhan Hubei
- Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University; Changsha China
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18
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Liu S, Pang Q, Zhang J, Zhai M, Liu S, Liu C. Machine perfusion versus cold storage of livers: a meta-analysis. Front Med 2016; 10:451-464. [PMID: 27837413 DOI: 10.1007/s11684-016-0474-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/19/2016] [Indexed: 12/18/2022]
Abstract
Different organ preservation methods are key factors influencing the results of liver transplantation. In this study, the outcomes of experimental models receiving donation after cardiac death (DCD) livers preserved through machine perfusion (MP) or static cold storage (CS) were compared by conducting a meta-analysis. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to compare pooled data from two animal species. Twenty-four studies involving MP preservation were included in the meta-analysis. Compared with CS preservation, MP can reduce the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and hyaluronic acid (HA) and the changes in liver weight. By contrast, MP can enhance bile production and portal vein flow (PVF). Alkaline phosphatase (ALP) levels and histological changes significantly differed between the two preservation methods. In conclusion, MP of DCD livers is superior to CS in experimental animals.
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Affiliation(s)
- Sushun Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Qing Pang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mimi Zhai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Sinan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China.
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19
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Quillin RC, Guarrera JV. Machine Perfusion for the Assessment and Resuscitation of Marginal Donors in Liver Transplantation. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0131-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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20
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Brant S, Holmes C, Cobert M, Powell L, Shelton J, Jessen M, Peltz M. Successful transplantation in canines after long-term coronary sinus machine perfusion preservation of donor hearts. J Heart Lung Transplant 2016; 35:1031-6. [PMID: 27160493 DOI: 10.1016/j.healun.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/01/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Machine perfusion is a promising strategy for donor heart preservation, but delivery of perfusate through the aorta may be limited by aortic valve incompetence. We hypothesized that retrograde machine perfusion preservation through the coronary sinus avoided this issue and allowed for recovery of donor hearts after long-term storage. METHODS Canine hearts were procured after arrest with 1 liter University of Wisconsin Machine Perfusion Solution (UWMPS) and preserved for 14 hours by static hypothermic storage (Static group, n = 5) or retrograde machine perfusion through the coronary sinus (RP group, n = 5). Myocardial oxygen consumption (MVo2) and lactate were monitored in perfused hearts. Hearts were implanted and reperfused for 6 hours. The pre-load recruitable stroke work was determined as a measure of myocardial function. Cardiac enzyme release was quantified. Cell death was evaluated by TUNEL (terminal deoxynucleotidyltransferase-mediated deoxy uridine triphosphate nick-end label). RESULTS MVo2 decreased initially then stabilized. Lactate accumulation was low in RP hearts. All RP hearts separated from cardiopulmonary bypass. All Static hearts required a return to bypass (p < .05). Pre-load recruitable stroke work in RP hearts was increased (55 ± 7 mm Hg) compared with Static (20 ± 11 mm Hg, p < .05) and did not differ from baseline values. Creatine kinase release was greater in Static group hearts (102 ± 16 IU/liter/g) than in RP hearts (51 ± 8 IU/liter/g, p < .05). The fraction of TUNEL-positive cells was higher in the Static group, but this difference was not significant. CONCLUSIONS Retrograde machine perfusion can preserve donor hearts for long intervals. Cardiac function after implantation suggested excellent myocardial protection. Retrograde machine perfusion appears promising for extending the donor ischemic interval and improving results of heart transplantation.
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Affiliation(s)
| | | | | | | | - John Shelton
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Dion MS, McGregor TB, McAlister VC, Luke PP, Sener A. Hypothermic machine perfusion improves Doppler ultrasonography resistive indices and long-term allograft function after renal transplantation: a single-centre analysis. BJU Int 2015; 116:932-7. [PMID: 25327417 DOI: 10.1111/bju.12960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate whether hypothermic machine perfusion (HMP) of transplanted kidneys can improve long-term renal allograft function compared with static cold storage (CS). METHODS We evaluated whether graft Doppler ultrasonography resistive indices improved with the use of HMP compared with CS preservation, and examined whether these improvements were predictive of long-term graft function. A total of 30 kidney transplants (15 pairs) were examined. One of the kidney pairs was placed on CS and transplanted first (CS group, n = 15). The other kidney of each pair was placed on HMP and transplanted after the CS group (HMP group, n = 15). Doppler ultrasonography was performed on days 1 and 7 after transplantation and resistive indices were evaluated. The estimated glomerular filtration rate (eGFR) was monitored for 24 months after transplantation. RESULTS Despite longer cold ischaemia times, kidneys maintained with HMP had lower resistive indices (P = 0.005) with correspondingly higher eGFR throughout the follow-up. Subgroup analysis showed that the HMP-induced improvement in postoperative eGFR was greatest in kidneys obtained from donation after cardiac death (DCD), even at 2 years after transplantation (P = 0.008). CONCLUSIONS HMP of transplant kidneys appears to improve vascular resistance after transplantation and has a positive impact on long-term allograft function compared with CS in the population of recipients of DCD kidneys.
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Affiliation(s)
- Marie S Dion
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Thomas B McGregor
- Department of Surgery, Division of Urology, University of Manitoba, Winnepeg, Manitoba, Canada
| | - Vivian C McAlister
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.,Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Patrick P Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.,Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada.,Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada.,Department of Microbiology and Immunology, Western University, London, Ontario, Canada.,Center for Human Immunology, Western University, London, Ontario, Canada.,Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada.,Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Center, London, Ontario, Canada
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22
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. EXP CLIN TRANSPLANT 2015; 13. [DOI: 10.6002/ect.2014.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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23
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Bon D, Delpech PO, Chatauret N, Hauet T, Badet L, Barrou B. Does machine perfusion decrease ischemia reperfusion injury? Prog Urol 2015; 24 Suppl 1:S44-50. [PMID: 24950933 DOI: 10.1016/s1166-7087(14)70063-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 1990's, use of machine perfusion for organ preservation has been abandoned because of improvement of preservation solutions, efficient without perfusion, easy to use and cheaper. Since the last 15 years, a renewed interest for machine perfusion emerged based on studies performed on preclinical model and seems to make consensus in case of expanded criteria donors or deceased after cardiac death donations. We present relevant studies highlighted the efficiency of preservation with hypothermic machine perfusion compared to static cold storage. Machines for organ preservation being in constant evolution, we also summarized recent developments included direct oxygenation of the perfusat. Machine perfusion technology also enables organ reconditioning during the last hours of preservation through a short period of perfusion on hypothermia, subnormothermia or normothermia. We present significant or low advantages for machine perfusion against ischemia reperfusion injuries regarding at least one primary parameter: risk of DFG, organ function or graft survival.
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Affiliation(s)
- D Bon
- Inserm U1082, Poitiers F-86021, France ; université de Poitiers, faculté de Médecine et de Pharmacie, F-86034 Poitiers, France
| | - P-O Delpech
- Inserm U1082, Poitiers F-86021, France ; université de Poitiers, faculté de Médecine et de Pharmacie, F-86034 Poitiers, France; Service d'Urologie, CHU La Miletrie, 86000 Poitiers, France
| | - N Chatauret
- Service d'Urologie, CHU La Miletrie, 86000 Poitiers, France
| | - T Hauet
- Inserm U1082, Poitiers F-86021, France ; université de Poitiers, faculté de Médecine et de Pharmacie, F-86034 Poitiers, France.
| | - L Badet
- Inserm U1082, Poitiers F-86021, France ; université de Poitiers, faculté de Médecine et de Pharmacie, F-86034 Poitiers, France; Service d'Urologie, CHU Edouard Herriot, 69000 Lyon, France
| | - B Barrou
- Inserm U1082, Poitiers F-86021, France ; université de Poitiers, faculté de Médecine et de Pharmacie, F-86034 Poitiers, France; Service d'Urologie, Service de Transplantation rénale et pancréatique, CHU la Pitié Salpêtrière, AP-HP, 75013 Paris, France
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24
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Influence of oxygen concentration during hypothermic machine perfusion on porcine kidneys from donation after circulatory death. Transplantation 2015; 98:944-50. [PMID: 25369373 DOI: 10.1097/tp.0000000000000379] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) for preservation led to compelling success for outcomes of renal transplantation. Application of different concentrations of oxygen during renal HMP has not been systematically analyzed. This study investigates the aspects of renal function and morphology in dependence of oxygen concentrations during HMP in a porcine donation after circulatory death model. METHODS After 30 min of warm ischemia, porcine kidneys were randomly assigned to preservation for 21 hr by HMP without oxygenation (HMPnoox), oxygenated HMP with air (HMPair), or 100% oxygen (HMPox100%). Afterward, kidneys were reperfused for 2 hr in an ex vivo model for assessment of function and integrity. RESULTS Application of HMPox100% led to significantly increased blood flow during reperfusion compared to HMPnoox. Preservation by HMPox100% led to a doubling of creatinine clearance after 90 and 120 min of reperfusion (13.4 and 12.0 mL/min) compared to preservation by HMPnoox (7.3 and 7.7 mL/min; P=0.01). Oxygenated HMP with air led to results between the two other groups. Fractional excretion of sodium demonstrated a strong tendency of higher values after HMPnoox compared to HMPox100% (P=0.096) and HMPair (P=0.09). Analysis of structural integrity during reperfusion demonstrated significantly higher values of lactate dehydrogenase resembling cell damage (P=0.02), higher values of gamma-glutamyl-transferase (gGT) resembling tubulus injury (P=0.048), and more pronounced tubular dilatation (P=0.02) after HMPnoox compared to HMPox100%. CONCLUSION The present study demonstrates that application of HMPox100% for kidneys from donations after circulatory death results in better renal function during early reperfusion compared to HMPnoox.
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25
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Nath J, Guy A, Smith TB, Cobbold M, Inston NG, Hodson J, Tennant DA, Ludwig C, Ready AR. Metabolomic perfusate analysis during kidney machine perfusion: the pig provides an appropriate model for human studies. PLoS One 2014; 9:e114818. [PMID: 25502759 PMCID: PMC4264773 DOI: 10.1371/journal.pone.0114818] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hypothermic machine perfusion offers great promise in kidney transplantation and experimental studies are needed to establish the optimal conditions for this to occur. Pig kidneys are considered to be a good model for this purpose and share many properties with human organs. However it is not established whether the metabolism of pig kidneys in such hypothermic hypoxic conditions is comparable to human organs. METHODS Standard criteria human (n = 12) and porcine (n = 10) kidneys underwent HMP using the LifePort Kidney Transporter 1.0 (Organ Recovery Systems) using KPS-1 solution. Perfusate was sampled at 45 minutes and 4 hours of perfusion and metabolomic analysis performed using 1-D 1H-NMR spectroscopy. RESULTS There was no inter-species difference in the number of metabolites identified. Of the 30 metabolites analysed, 16 (53.3%) were present in comparable concentrations in the pig and human kidney perfusates. The rate of change of concentration for 3-Hydroxybutyrate was greater for human kidneys (p<0.001). For the other 29 metabolites (96.7%), there was no difference in the rate of change of concentration between pig and human samples. CONCLUSIONS Whilst there are some differences between pig and human kidneys during HMP they appear to be metabolically similar and the pig seems to be a valid model for human studies.
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Affiliation(s)
- Jay Nath
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Alison Guy
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Thomas B. Smith
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Mark Cobbold
- Department of Immunity & Infection, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas G. Inston
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
| | - James Hodson
- Wolfson Computer Laboratory, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Daniel A. Tennant
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christian Ludwig
- Henry Wellcome Building for Biomolecular NMR Spectroscopy, University of Birmingham, Birmingham, United Kingdom
| | - Andrew R. Ready
- Department of Renal Surgery, University Hospitals Birmingham, Birmingham, United Kingdom
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26
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Characterizing Cardiac Donation After Circulatory Death: Implications for Perfusion Preservation. Ann Thorac Surg 2014; 98:2107-13; discussion 2113-4. [DOI: 10.1016/j.athoracsur.2014.05.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/15/2014] [Accepted: 05/22/2014] [Indexed: 11/23/2022]
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27
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Hoyer DP, Gallinat A, Swoboda S, Wohlschläger J, Rauen U, Paul A, Minor T. Subnormothermic machine perfusion for preservation of porcine kidneys in a donation after circulatory death model. Transpl Int 2014; 27:1097-106. [PMID: 24963744 DOI: 10.1111/tri.12389] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 05/12/2014] [Accepted: 06/23/2014] [Indexed: 01/26/2023]
Abstract
Machine perfusion for preservation led to compelling success for the outcome of renal transplantation. Further refinements of methods to decrease preservation injury remain an issue of high interest. This study investigates functional and morphological aspects of kidneys preserved by subnormothermic (20 °C) machine perfusion (SNTM) compared with oxygenated hypothermic machine perfusion (HMPox) and cold storage (CS) in a donation after circulatory death (DCD) model. After 30 min of warm ischaemia, porcine kidneys were randomly assigned to preservation for 7 h by CS, HMPox or SNTM. Afterwards, kidneys were reperfused for 2 h with autologous blood in vitro for assessment of function and integrity. Application of SNTM for preservation led to significantly higher blood flow and urine output compared with both other groups. SNTM led to a twofold increased creatinine clearance compared with HMPox and 10-fold increased creatinine clearance compared with CS. Structural integrity was best preserved by SNTM. In conclusion, this is the first study on SNTM for kidneys from DCD donors. SNTM seems to be a promising preservation method with the potential to improve functional parameters of kidneys during reperfusion.
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Affiliation(s)
- Dieter P Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
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Gallinat A, Efferz P, Paul A, Minor T. One or 4 h of "in-house" reconditioning by machine perfusion after cold storage improve reperfusion parameters in porcine kidneys. Transpl Int 2014; 27:1214-9. [PMID: 24977654 DOI: 10.1111/tri.12393] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 04/22/2014] [Accepted: 06/26/2014] [Indexed: 12/01/2022]
Abstract
In-house machine perfusion after cold storage (hypothermic reconditioning) has been proposed as convenient tool to improve kidney graft function. This study investigated the role of machine perfusion duration for early reperfusion parameters in porcine kidneys. Kidney function after cold preservation (4 °C, 18 h) and subsequent reconditioning by one or 4 h of pulsatile, nonoxygenated hypothermic machine perfusion (HMP) was studied in an isolated kidney perfusion model in pigs (n = 6, respectively) and compared with simply cold-stored grafts (CS). Compared with CS alone, one or 4 h of subsequent HMP similarly and significantly improved renal flow and kidney function (clearance and sodium reabsorption) upon warm reperfusion, along with reduced perfusate concentrations of endothelin-1 and increased vascular release of nitric oxide. Molecular effects of HMP comprised a significant (vs CS) mRNA increase in the endothelial transcription factor KLF2 and lower expression of endothelin that were observed already at the end of one-hour HMP after CS. Reconditioning of cold-stored kidneys is possible, even if clinical logistics only permit one hour of therapy, while limited extension of the overall storage time by in-house machine perfusion might also allow for postponing of transplantation from night to early day work.
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Affiliation(s)
- Anja Gallinat
- Clinic of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany
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Brant S, Rosenbaum D, Cobert M, West L, Jessen M, Peltz M. Effects of Antegrade and Retrograde Machine Perfusion Preservation on Cardiac Function After Transplantation in Canines. Transplant Proc 2014; 46:1601-5. [DOI: 10.1016/j.transproceed.2014.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/12/2014] [Indexed: 11/16/2022]
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Wszola M, Kwiatkowski A, Domagala P, Wirkowska A, Bieniasz M, Diuwe P, Kieszek R, Durlik M, Chmura A. Preservation of Kidneys by Machine Perfusion Influences Gene Expression and May Limit Ischemia/Reperfusion Injury. Prog Transplant 2014; 24:19-26. [DOI: 10.7182/pit2014384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Context Machine perfusion improves graft survival. Histopathologic analysis reveals a lower incidence of chronic rejection and interstitial fibrosis in kidneys preserved with machine perfusion. Ischemic/reperfusion injury may help to explain these findings. Objective To assess the activation of genes correlated with ischemic/reperfusion injury in kidneys preserved under different conditions before transplant. Design/Patients Between 2005 and 2006, 69 kidney biopsy specimens were collected and patients were followed up for 5 years after that. Intervention Before transplant, kidneys were preserved with machine perfusion or cold storage. Donors from the machine perfusion and cold storage groups did not differ with regard to age, sex, or hemodynamic status. Recipients were divided into 5 groups: expanded criteria donor–machine perfusion (n = 16), standard criteria donor–machine perfusion (n = 10), expanded criteria donor–cold storage (n = 9), and standard criteria donor–cold storage (n = 27); 7 kidneys were retrieved from living related donors. Main Outcome Measures Biopsies were done 30 minutes after reperfusion. Interleukin-1β, vascular endothelial growth factor, heme oxygenase-1, and hypoxia-inducible factor–1 gene expression levels were analyzed. Results Mean expression levels of hypoxia-inducible factor–1α were significantly higher in the cold storage groups, and lower in the machine perfusion and living-related donor groups. Five-year graft survival was significantly ( P < .05) lower in the expanded criteria donor–cold storage group (66%) than in the standard criteria donor–machine perfusion group (90%). Machine perfusion influences gene expression related to hypoxia during reperfusion and may improve the long-term results of kidney transplant.
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Elec FI, Lucan C, Ghervan L, Munteanu V, Moga S, Suciu M, Enache D, Elec A, Munteanu A, Barbos A, Iacob G, Lucan M. Ex-vivo perfusion machines in kidney transplantation. The significance of the resistivity index. CLUJUL MEDICAL 2014; 87:27-9. [PMID: 26527992 PMCID: PMC4462411 DOI: 10.15386/cjm.2014.8872.871.fie1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/10/2014] [Indexed: 11/23/2022]
Abstract
Introduction With a growing shortage of organs for transplantation, finding ways of increasing the donor organ pool remains of utmost importance. Perfusion machines (PM) have been proven to enhance the potential for kidney transplants to function sooner, last longer, giving patients the opportunity for a better life quality. Objective The aim of this study is to evaluate the relation between the resistance index provided by the PM, the postoperative resistance index measured by Doppler ultrasound and the initial graft outcome. Material and method Between January 2012-December 2012, clinical data obtained from 82 consecutive renal transplants from brain death donors (BDD) which underwent PM maintenance were analyzed in a transversal study. Prior transplantation we recorded the solution temperature, filtration rate and the resistance index provided by PM. After the surgical intervention, each patient had standard follow-up. Doppler ultrasound resistivity index (RI) was recorded on the first postoperative day. Results Out of 115 renal transplants, 98 (85.21%) were performed with grafts from BDD. The PM was used for 82 renal grafts. The Doppler resistance index in relation to the resistance index shows a highly statistical correlation by linear regression (R=0.813, p<0.0001). Primary graft function was recorded in 74 patients (90.24%) and it was highly statistically significant correlated with the resistance index measured by PM. Out of 8 patients with primary non-function, 6 patients recovered with normal graft function at one year. Conclusion The resistivity index recorded by the life-port machine is correlated with the vascular resistivity index measured by Doppler ultrasound and thus it may predicts the primary graft outcome.
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Affiliation(s)
- Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Ciprian Lucan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Liviu Ghervan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | | | - Silviu Moga
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Mihai Suciu
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Dan Enache
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Alina Elec
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Adriana Munteanu
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Adrian Barbos
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Gheorghita Iacob
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
| | - Mihai Lucan
- Clinical Institute of Urology and Renal Transplantation Cluj-Napoca
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The Benefits of Pulsatile Machine Perfusion of Standard Criteria Deceased Donor Kidneys at a Geographically Remote Transplant Center. ASAIO J 2014; 60:76-80. [DOI: 10.1097/mat.0000000000000014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Role of Pulsatility in Hypothermic Reconditioning of Porcine Kidney Grafts by Machine Perfusion After Cold Storage. Transplantation 2013; 96:538-42. [DOI: 10.1097/tp.0b013e31829c24e2] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wszola M, Kwiatkowski A, Diuwe P, Domagała P, Górski L, Kieszek R, Berman A, Perkowska-Ptasińska A, Durlik M, Pączek L, Chmura A. One-year results of a prospective, randomized trial comparing two machine perfusion devices used for kidney preservation. Transpl Int 2013; 26:1088-96. [PMID: 24033725 DOI: 10.1111/tri.12169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 02/23/2013] [Accepted: 07/21/2013] [Indexed: 02/03/2023]
Abstract
Studies have shown beneficial effects of machine perfusion (MP) on early kidney function and long-term graft survival. The aim of this study was to investigate whether the type of perfusion device could affect outcome of transplantation of deceased donor kidneys. A total of 50 kidneys retrieved from 25 donors were randomized to machine perfusion using a flow-driven (FD) device (RM3; Waters Medical Inc) or a pressure-driven (PD) device (LifePort; Organ Recovery Systems), 24 of these kidneys (n = 12 pairs; 48%) were procured from expanded criteria donors (ECD). The primary endpoints were kidney function after transplantation defined using the incidence of delayed graft function (DGF), the number of hemodialysis sessions required, graft function at 12 months, and analyses of biopsy. DGF was similar in both groups (32%; 8/25). Patients with DGF in the FD group required a mean of 4.66 hemodialysis sessions versus 2.65 in the PD group (P = 0.005). Overall, 1-year graft survival was 80% (20/25) vs. 96% (24/25) in the FD and PD groups. One-year graft survival of ECD kidneys was 66% (8/12) in the FD group versus 92% (11/12) in the PD group. Interstitial fibrosis and tubular atrophy were significantly more common in the FD group - 45% (5/11) vs. 0% (0/9) (P = 0.03) in PD group. There were no differences in creatinine levels between the groups. Machine perfusion using a pressure-driven device generating lower pulse stress is superior to a flow-driven device with higher pulse stress for preserving kidney function.
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Affiliation(s)
- Michal Wszola
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland
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Suszynski TM, Rizzari MD, Scott WE, Eckman PM, Fonger JD, John R, Chronos N, Tempelman LA, Sutherland DER, Papas KK. Persufflation (gaseous oxygen perfusion) as a method of heart preservation. J Cardiothorac Surg 2013; 8:105. [PMID: 23607734 PMCID: PMC3639186 DOI: 10.1186/1749-8090-8-105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/11/2013] [Indexed: 01/10/2023] Open
Abstract
Persufflation (PSF; gaseous oxygen perfusion) is an organ preservation technique with a potential for use in donor heart preservation. Improved heart preservation with PSF may improve outcomes by maintaining cardiac tissue quality in the setting of longer cold ischemia times and possibly increasing the number of donor hearts available for allotransplant. Published data suggests that PSF is able to extend the cold storage times for porcine hearts up to 14 hours without compromising viability and function, and has been shown to resuscitate porcine hearts following donation after cardiac death. This review summarizes key published work on heart PSF, including prospective implications and future directions for PSF in heart transplantation. We emphasize the potential impact of extending preservation times and expanding donor selection criteria in heart allotransplant. Additionally, the key issues that need to be addressed before PSF were to become a widely utilized preservation strategy prior to clinical heart transplantation are summarized and discussed.
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Affiliation(s)
- Thomas M Suszynski
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Gallinat A, Moers C, Smits JM, Strelniece A, Pirenne J, Ploeg RJ, Paul A, Treckmann J. Machine perfusion versus static cold storage in expanded criteria donor kidney transplantation: 3-year follow-up data. Transpl Int 2013; 26:E52-3. [DOI: 10.1111/tri.12094] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anja Gallinat
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; Essen; Germany
| | - Cyril Moers
- Department of Surgery; University Medical Center Groningen; University of Groningen; Groningen; The Netherlands
| | | | - Agita Strelniece
- Eurotransplant International Foundation; Leiden; The Netherlands
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery - Transplant Coordination; University Hospital Leuven; Leuven; Belgium
| | - Rutger J. Ploeg
- Oxford Transplant Centre; John Radcliffe Hospital; Oxford; UK
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; Essen; Germany
| | - Jürgen Treckmann
- Department of General, Visceral and Transplantation Surgery; University Hospital Essen; Essen; Germany
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Low-flow perfusion preservation versus static preservation for isolated rat heart: effects on recovery of myocardial function. Transplant Proc 2013; 45:523-7. [PMID: 23498788 DOI: 10.1016/j.transproceed.2012.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/23/2012] [Accepted: 08/30/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Clinically, donor hearts cannot be preserved for >6 hours between explantation and recipient implantation. A better approach is needed to preserve donor hearts for a longer time. We tested whether low-flow perfusion (LFP) could satisfactorily preserve isolated rat hearts with histidine-tryptophan-ketoglutarate (HTK) solution or Fuwai modified (FWM) solution. METHODS We divided 32 male Sprague-Dawley rats randomly into 4 groups (n = 8): H1, H2, F1, and F2. The Langendorff heart model immersed isolated hearts in the H1 and F1 groups in HTK or FWM solution for 8 hours at 4 °C. Isolated hearts in the H2 and F2 groups were low-flow perfused with HTK solution and FWM solution for 8 hours at a pressure of 10 cmH(2)O at 4 °C. After 60 minutes reperfusion, we measured recovery of cardiac function, myocardial water content, and leakage of myocardial enzymes. RESULTS After reperfusion, no cardiac rebeating was observed among F1 group hearts; in addition, they showed significantly higher myocardial water content and lactate dehydrogenase leakage compared with the other 3 groups (P < .05). The recovery rates of cardiac function among H2 hearts were better than the other 3 groups (P < .05); their myocardial water content and enzyme leakage were less than the other 3 groups (P < .05). CONCLUSIONS Hypothermic LFP was better than static storage to preserve isolated rat hearts. HTK solution afforded better myocardial protection than FWM.
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Domagała P, Kwiatkowski A, Drozdowski J, Ostrowski K, Wszola M, Diuwe P, Durlik M, Paczek L, Chmura A. Successful outcome of transplant of kidneys recovered from a brain-dead liver transplant recipient: case report. Prog Transplant 2012. [PMID: 23187061 DOI: 10.7182/pit2012953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Few reports describing the use of organs donated by transplant recipients have been published. In this case report, kidneys procured from a brain-dead liver recipient were transplanted successfully. A 21-year-old man was referred for liver transplant after an overdose of acetaminophen. The patient's kidney function was initially normal, with proper urine production and normal kidney laboratory parameters. On the third day after admission, the patient's kidney laboratory parameters became elevated and hepatic encephalopathy requiring mechanical ventilation developed. An orthotopic liver transplant was performed the next day. The patient did not recover consciousness, and brain death was diagnosed on the third day after the liver transplant surgery. The maximum serum concentration of creatinine was 5.8 mg/dL (513 μmol/L) before kidney recovery, and urine production was normal. The kidneys were recovered with organ-perfusion support and were preserved by using machine perfusion. The kidneys were transplanted into 2 male recipients. Twelve months after transplant, the recipients remained in good health with satisfactory kidney function. This case demonstrates that transplanting kidneys recovered from liver transplant recipients is possible and beneficial, thus expanding the pool of potential donors.
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Role of Oxygenation in Hypothermic Machine Perfusion of Kidneys From Heart Beating Donors. Transplantation 2012; 94:809-13. [DOI: 10.1097/tp.0b013e318266401c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yushkov YY, Stern J, Ying A, Icitovic N, Dikman SH, Sheth M, Goldstein MJ. Identifying risk factors in renal allografts before transplant: machine-measured renal resistance and posttransplant allograft survival. Prog Transplant 2012; 22:175-82. [PMID: 22878075 DOI: 10.7182/pit2012968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Enhancement of renal allograft function and survival in an era where expanded criteria donors are increasingly used requires validated selection criteria. The goal of this retrospective study was to evaluate the significance of pretransplant donor and allograft parameters to identify risk factors that can be used in a model to predict 1-year allograft outcomes. Donor demographic factors, donor type, and allograft parameters such as biopsy results and machine-measured renal resistance were correlated with 1-year graft outcome. The Kaplan-Meier method was used to estimate graft survival using the categorical predictors of donor type, donor age, and machine measured renal resistance at 1.5, 3, and 5 hours. The log-rank test was used to test the difference in survival curves between cohorts. The Cox regression analysis was used to estimate hazard ratios for machine-measured renal resistance, donor age, donor terminal creatinine level, donor's estimated glomerular filtration rate, cold ischemia time, and percent glomerulosclerosis. The data show that machine-measured renal resistance at 3 and 5 hours has a statistically significant inverse relationship to 1-year graft survival. All other risk factors had no correlation with 1-year graft survival. The machine-measured renal resistance at 3 hours is the earliest significant predictor of 1-year allograft outcome.
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Bon D, Chatauret N, Giraud S, Thuillier R, Favreau F, Hauet T. New strategies to optimize kidney recovery and preservation in transplantation. Nat Rev Nephrol 2012; 8:339-47. [DOI: 10.1038/nrneph.2012.83] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Henry SD, Guarrera JV. Protective effects of hypothermic ex vivo perfusion on ischemia/reperfusion injury and transplant outcomes. Transplant Rev (Orlando) 2011; 26:163-75. [PMID: 22074785 DOI: 10.1016/j.trre.2011.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 07/08/2011] [Accepted: 09/02/2011] [Indexed: 12/14/2022]
Abstract
Hypothermic machine preservation (HMP) has been used in renal transplantation since the late 1960s with recent robust prospective, multicenter data showing lower rates of delayed graft function and improved graft survival. Although now clearly beneficial for renal transplantation, extrarenal machine perfusion has remained predominantly in preclinical investigations. Pancreatic HMP has drawn little clinical interest because HMP has been suggested to cause graft edema and congestion, which is associated with early venous thrombosis and graft failure. Early investigation showed no benefit of HMP in whole-organ pancreas transplant. One report did show that HMP increases islet cell yield after isolation. Preclinical work in liver HMP has been promising. Short- and long-term HMP has been shown to improve graft viability and reduce preservation injury, even in animal models of steatotic and donation after cardiac death. The first clinical study of liver HMP using a centrifugal dual perfusion technique showed excellent results with lower hepatocellular injury markers and no adverse perfusion-related outcomes. In addition, a dramatic attenuation of proinflammatory cytokine expression was observed. Further studies of liver HMP are planned with focus on developing a reproducible and standard protocol that will allow the widespread availability of this technology. Future research and clinical trials of novel organ preservation techniques, solutions, and interventions are likely to bring about developments that will allow further reduction of preservation-related ischemia/reperfusion injury and improved outcomes and allow safer utilization of the precious and limited resource of donor organs.
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Affiliation(s)
- Scot D Henry
- Division of Abdominal Organ Transplantation and Molecular Therapies and Organ Preservation Research Laboratory, Department of Surgery Columbia University Medical Center, New York, NY 10032-3784, USA
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Differences in Regional Myocardial Perfusion, Metabolism, MVO2, and Edema After Coronary Sinus Machine Perfusion Preservation of Canine Hearts. ASAIO J 2011; 57:481-6. [DOI: 10.1097/mat.0b013e31823769d5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tulipan JE, Stone J, Samstein B, Kato T, Emond JC, Henry SD, Guarrera JV. Molecular expression of acute phase mediators is attenuated by machine preservation in human liver transplantation: preliminary analysis of effluent, serum, and liver biopsies. Surgery 2011; 150:352-60. [PMID: 21801971 DOI: 10.1016/j.surg.2011.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 06/13/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) mitigates the effects of ischemia/reperfusion injury (IRI) in renal transplantation and preclinical work with livers. In liver transplantation, IRI increases the likelihood of primary graft dysfunction and is associated with significant morbidity. We recently completely the first phase 1 clinical trial of liver HMP at our center, and demonstrated improved clinical parameters and shorter duration of stay for patients who received grafts stored by HMP than patients who received grafts preserved in cold storage. Biomarker analysis of venous effluent collected from the hepatic veins during HMP may yield predictive information reflecting the condition of the donor liver, such as graft injury sustained during brain death and graft preservation. The aim of this study was to characterize biomarkers released into the effluent during HMP. METHODS Effluent was collected every 30 minutes during liver HMP during our phase 1 clinical trial. Serum was extracted from blood samples obtained at incision, before explantation, and at 1, 2, and 3 hours after reperfusion. The effluent and serum samples were assayed in multiplex to determine the concentration of inflammatory cytokines and growth factors. Tissue obtained from liver biopsies was processed for either downstream reverse transcription-polymerase chain reaction or immunofluorescence. Statistical significance was determined by a two-tailed t-test. RESULTS Growth factors and most cytokines were not readily detectable in levels above baseline with this technique; however, interleukin-1 (IL-1) receptor antagonist and monocyte chemotactic protein-1 were present in significant concentrations in the effluent at all time points. This finding was confirmed with serum samples and mRNA expression obtained from liver biopsies. The concentrations of these proteins decreased from their initial values over the course of HMP, and mRNA expression levels were decreased by the use of HMP. CONCLUSION IL-1β and tumor necrosis factor (TNF)-α are key mediators of inflammation in IRI. Although difficult to measure because of short half-lives, their downstream effectors indicate their levels of activity. IL-1 receptor antagonist is secreted in response to IL-1β, and monocyte chemotactic protein in response to TNF-α. Their decreased production over the course of HMP suggests that interruption of acute-phase inflammation in the graft may attenuate reperfusion-related graft injury. Further cDNA studies and effluent analyses are required to confirm this hypothesis.
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Affiliation(s)
- Jacob E Tulipan
- Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY 10032, USA
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Vaziri N, Thuillier R, Favreau FD, Eugene M, Milin S, Chatauret NP, Hauet T, Barrou B. Analysis of machine perfusion benefits in kidney grafts: a preclinical study. J Transl Med 2011; 9:15. [PMID: 21266040 PMCID: PMC3038164 DOI: 10.1186/1479-5876-9-15] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 01/25/2011] [Indexed: 12/22/2022] Open
Abstract
Background Machine perfusion (MP) has potential benefits for marginal organs such as from deceased from cardiac death donors (DCD). However, there is still no consensus on MP benefits. We aimed to determine machine perfusion benefits on kidney grafts. Methods We evaluated kidney grafts preserved in ViaspanUW or KPS solutions either by CS or MP, in a DCD pig model (60 min warm ischemia + 24 h hypothermic preservation). Endpoints were: function recovery, quality of function during follow up (3 month), inflammation, fibrosis, animal survival. Results ViaspanUW-CS animals did not recover function, while in other groups early follow up showed similar values for kidney function. Alanine peptidase and β-NAG activities in the urine were higher in CS than in MP groups. Oxydative stress was lower in KPS-MP animals. Histology was improved by MP over CS. Survival was 0% in ViaspanUW-CS and 60% in other groups. Chronic inflammation, epithelial-to-mesenchymal transition and fibrosis were lowest in KPS-MP, followed by KPS-CS and ViaspanUW-MP. Conclusions With ViaspanUW, effects of MP are obvious as only MP kidney recovered function and allowed survival. With KPS, the benefits of MP over CS are not directly obvious in the early follow up period and only histological analysis, urinary tubular enzymes and red/ox status was discriminating. Chronic follow-up was more conclusive, with a clear superiority of MP over CS, independently of the solution used. KPS was proven superior to ViaspanUW in each preservation method in terms of function and outcome. In our pre-clinical animal model of DCD transplantation, MP offers critical benefits.
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Favorable outcomes with machine perfusion and longer pump times in kidney transplantation: a single-center, observational study. Transplantation 2010; 90:882-90. [PMID: 20703178 DOI: 10.1097/tp.0b013e3181f2c962] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time. METHODS We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators. RESULTS Mean cold storage and pump times were 6.6 and 26.7 hr, consistent across immunosuppression protocols. Overall DGF and SGF rates were 4.4% (15/339) and 12.1% (41/339). DGF was equally low for pump time less than 24 vs. more than or equal to 24 hr, 5.2% (6/116) vs. 4.0% (9/223) (P=0.63), with similar results after adjusting for known DGF predictors. A significantly lower first BPAR rate was observed for longer pump time (as a continuous variable) among more immunologically active recipients (those having more risk factors: DGF, age <50 yr, and non-white) (univariable P=0.005; multivariable P=0.009), with an estimated hazard ratio of 0.43 (P=0.006) favoring pump time more than or equal to 24 hr among those with more than or equal to two risk factors. CONCLUSIONS.: In this single-center, observational study, MP with prolonged pump times was associated with low DGF/SGF and first BPAR rates, supporting continued use of MP.
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Santana AC, Marinotto DBE, Dellê H, Cordeiro AC, Noronha IL. Effectiveness of thalidomide and tamoxifen in preventing neointimal hyperplasia in experimental vascular injury in rats. Transplant Proc 2010; 42:585-8. [PMID: 20304198 DOI: 10.1016/j.transproceed.2010.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic allograft vasculopathy is an important cause of graft loss. Considering the inflammatory response in the development of chronic vascular lesions, therapeutic approaches to target the inflammatory process may be useful. We sought to investigate the possible protective effects on balloon catheter-induced vascular injury of thalidomide and tamoxifen, 2 drugs with powerful anti-inflammatory, immunomodulatory, and antifibrotic effects, using an animal model that mimics the morphologic features of chronic allograft vasculopathy. METHODS Male Wistar rats subjected to balloon catheter carotid injury (INJ) were treated with thalidomide (100 mg/kg), or tamoxifen (10 mg/kg), or vehicle. Contralateral right carotid arteries were used as uninjured controls. Morphometric and immunohistochemical analyses were performed at 14 days postinjury. RESULTS Injured carotid arteries showed marked neointimal hyperplasia, which was significantly inhibited among animals treated with thalidomide or tamoxifen: neointimal/media ratios of 1.4 +/- 0.4 versus 0.2 +/- 0.1 versus 0.4 +/- 0.2, for INJ, INJ + Thalid, and INJ + Tamox; respectively (P < .001). The endothelial cell loss was significantly less pronounced among animals subjected to carotid balloon injury that were treated with thalidomide (24 +/- 14 vs 1 +/- 1 cells per section in INJ, respectively (P < .05). Therapy with either thalidomide or tamoxifen effectively maintained alpha-smooth muscle actin expression in the media, similar to uninjured arteries. In this setting, tamoxifen was additionally effective to prevent the migration of myofibroblasts in to the intima. CONCLUSION Thalidomide and tamoxifen were effective to reduce neointimal hyperplasia secondary to vascular damage. The vasculoprotective effects of thalidomide were more pronounced to preserve endothelial cells, whereas tamoxifen inhibited smooth muscle cell migration and proliferation. A possible beneficial effect of combined therapy with thalidomide plus tamoxifen should be addressed in future studies.
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Affiliation(s)
- A C Santana
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo, Sao Paulo, Brazil
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Taylor MJ, Baicu SC. Current state of hypothermic machine perfusion preservation of organs: The clinical perspective. Cryobiology 2010; 60:S20-35. [PMID: 19857479 PMCID: PMC2891866 DOI: 10.1016/j.cryobiol.2009.10.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 10/01/2009] [Accepted: 10/20/2009] [Indexed: 01/16/2023]
Abstract
This review focuses on the application of hypothermic perfusion technology as a topic of current interest with the potential to have a salutary impact on the mounting clinical challenges to improve the quantity and quality of donor organs and the outcome of transplantation. The ex vivo perfusion of donor organs on a machine prior to transplant, as opposed to static cold storage on ice, is not a new idea but is being re-visited because of the prospects of making available more and better organs for transplantation. The rationale for pursuing perfusion technology will be discussed in relation to emerging data on clinical outcomes and economic benefits for kidney transplantation. Reference will also be made to on-going research using other organs with special emphasis on the pancreas for both segmental pancreas and isolated islet transplantation. Anticipated and emerging benefits of hypothermic machine perfusion of organs are: (i) maintaining the patency of the vascular bed, (ii) providing nutrients and low demand oxygen to support reduced energy demands, (iii) removal of metabolic by-products and toxins, (iv) provision of access for administration of cytoprotective agents and/or immunomodulatory drugs, (v) increase of available assays for organ viability assessment and tissue matching, (vi) facilitation of a change from emergency to elective scheduled surgery with reduced costs and improved outcomes, (vii) improved clinical outcomes as demonstrated by reduced PNF and DGF parameters, (viii) improved stabilization or rescue of ECD kidneys or organs from NHBD that increase the size of the donor pool, (ix) significant economic benefit for the transplant centers and reduced health care costs, and (x) provision of a technology for ex vivo use of non-transplanted human organs for pharmaceutical development research.
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Importance of Organ Preservation Solution Composition in Reducing Myocardial Edema during Machine Perfusion for Heart Transplantation. Transplant Proc 2010; 42:1591-4. [DOI: 10.1016/j.transproceed.2010.02.073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/18/2010] [Accepted: 02/02/2010] [Indexed: 11/21/2022]
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Guarrera JV, Henry SD, Chen SWC, Brown T, Nachber E, Arrington B, Boykin J, Samstein B, Brown RS, Emond JC, Lee HT. Hypothermic machine preservation attenuates ischemia/reperfusion markers after liver transplantation: preliminary results. J Surg Res 2010; 167:e365-73. [PMID: 20451921 DOI: 10.1016/j.jss.2010.01.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 12/30/2009] [Accepted: 01/25/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) has shown significant benefits in renal transplantation but is still in its infancy in liver transplantation. Potential benefits include diminished preservation injury and improved early graft function. METHODS We analyzed liver tissue and effluent collected during our Phase 1 trial of liver HMP. Liver allografts underwent HMP for 4-7 h using dual centrifugal perfusion with Vasosol solution at 4-8°C were transplanted and compared with cold stored (CS) transplant controls. Histology, reverse transcription-polymerase chain reaction (RT-PCR), and immunohistochemistry on liver biopsies compared histology and expression of early proinflammatory cytokines, IL-8 and TNF-α, and intracellular adhesion molecule-1 (ICAM-1). Gel electrophoresis was used to evaluate effluent protein content representing residual metabolism. RESULTS We saw no differences between HMP and CS in early histologic findings after reperfusion. RT-PCR of reperfusion biopsy samples in the CS group showed high expression of proinflammatory cytokines and ICAM-1. This up-regulation was significantly attenuated by HMP (ICAM-1; P = 0.0152) (IL-8; P = 0.0014) (TNF-α; P = 0.0284). This was confirmed with immunohistochemistry. Albumin was identified in the perfusate throughout HMP. CONCLUSIONS HMP significantly reduced proinflammatory cytokine expression compared with CS controls. Further studies of human liver HMP with detailed molecular investigations are now warranted to elucidate benefits of HMP in liver transplantation.
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Affiliation(s)
- James V Guarrera
- Department of Surgery, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, 622 West 168th Street PH 14 Center, Room 202, New York, NY 10032, USA.
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