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Abdominal Organ Preservation Solutions in the Age of Machine Perfusion. Transplantation 2023; 107:326-340. [PMID: 35939388 DOI: 10.1097/tp.0000000000004269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The past decade has been the foreground for a radical revolution in the field of preservation in abdominal organ transplantation. Perfusion has increasingly replaced static cold storage as the preferred and even gold standard preservation method for marginal-quality organs. Perfusion is dynamic and offers several advantages in comparison with static cold storage. These include the ability to provide a continuous supply of new metabolic substrates, clear metabolic waste products, and perform some degree of organ viability assessment before actual transplantation in the recipient. At the same time, the ongoing importance of static cold storage cannot be overlooked, in particular when it comes to logistical and technical convenience and cost, not to mention the fact that it continues to work well for the majority of transplant allografts. The present review article provides an overview of the fundamental concepts of organ preservation, providing a brief history of static cold preservation and description of the principles behind and basic components of cold preservation solutions. An evaluation of current evidence supporting the use of different preservation solutions in abdominal organ transplantation is provided. As well, the range of solutions used for machine perfusion of abdominal organs is described, as are variations in their compositions related to changing metabolic needs paralleling the raising of the temperature of the perfusate from hypothermic to normothermic range. Finally, appraisal of new preservation solutions that are on the horizon is provided.
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Avolio AW, Contegiacomo A, Spoletini G, Moschetta G, Bianco G, Agnes S, Melcher ML, Burra P. Toward a novel evidence-based definition of early allograft failure in the perspective of liver retransplant. Transpl Int 2021; 34:2905-2907. [PMID: 34784075 DOI: 10.1111/tri.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alfonso W Avolio
- Divisione di Chirurgia Generale e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Translazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Contegiacomo
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Gabriele Spoletini
- Divisione di Chirurgia Generale e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Moschetta
- Divisione di Chirurgia Generale e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Bianco
- Divisione di Chirurgia Generale e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Salvatore Agnes
- Divisione di Chirurgia Generale e del Trapianto di Fegato, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Dipartimento di Medicina e Chirurgia Translazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc L Melcher
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Patrizia Burra
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Azienda ospedaliera universitaria, Padua, Italy
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Bardallo RG, da Silva RT, Carbonell T, Folch-Puy E, Palmeira C, Roselló-Catafau J, Pirenne J, Adam R, Panisello-Roselló A. Role of PEG35, Mitochondrial ALDH2, and Glutathione in Cold Fatty Liver Graft Preservation: An IGL-2 Approach. Int J Mol Sci 2021; 22:ijms22105332. [PMID: 34069402 PMCID: PMC8158782 DOI: 10.3390/ijms22105332] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/26/2023] Open
Abstract
The total damage inflicted on the liver before transplantation is associated with several surgical manipulations, such as organ recovery, washout of the graft, cold conservation in organ preservation solutions (UW, Celsior, HTK, IGL-1), and rinsing of the organ before implantation. Polyethylene glycol 35 (PEG35) is the oncotic agent present in the IGL-1 solution, which is an alternative to UW and Celsior solutions in liver clinical transplantation. In a model of cold preservation in rats (4 °C; 24 h), we evaluated the effects induced by PEG35 on detoxifying enzymes and nitric oxide, comparing IGL-1 to IGL-0 (which is the same as IGL-1 without PEG). The benefits were also assessed in a new IGL-2 solution characterized by increased concentrations of PEG35 (from 1 g/L to 5 g/L) and glutathione (from 3 mmol/L to 9 mmol/L) compared to IGL-1. We demonstrated that PEG35 promoted the mitochondrial enzyme ALDH2, and in combination with glutathione, prevented the formation of toxic aldehyde adducts (measured as 4-hydroxynonenal) and oxidized proteins (AOPP). In addition, PEG35 promoted the vasodilator factor nitric oxide, which may improve the microcirculatory disturbances in steatotic grafts during preservation and revascularization. All of these results lead to a reduction in damage inflicted on the fatty liver graft during the cold storage preservation. In this communication, we report on the benefits of IGL-2 in hypothermic static preservation, which has already been proved to confer benefits in hypothermic oxygenated dynamic preservation. Hence, the data reported here reinforce the fact that IGL-2 is a suitable alternative to be used as a unique solution/perfusate when hypothermic static and preservation strategies are used, either separately or combined, easing the logistics and avoiding the mixture of different solutions/perfusates, especially when fatty liver grafts are used. Further research regarding new therapeutic and pharmacological insights is needed to explore the underlying mitochondrial mechanisms exerted by PEG35 in static and dynamic graft preservation strategies for clinical liver transplantation purposes.
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Affiliation(s)
- Raquel G. Bardallo
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona (IIBB), CSIC-IDIBAPS, 08036 Barcelona, Spain; (R.G.B.); (R.T.d.S.); (E.F.-P.); (A.P.-R.)
- Department of Physiology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain;
| | - Rui Teixeira da Silva
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona (IIBB), CSIC-IDIBAPS, 08036 Barcelona, Spain; (R.G.B.); (R.T.d.S.); (E.F.-P.); (A.P.-R.)
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal;
| | - Teresa Carbonell
- Department of Physiology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain;
| | - Emma Folch-Puy
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona (IIBB), CSIC-IDIBAPS, 08036 Barcelona, Spain; (R.G.B.); (R.T.d.S.); (E.F.-P.); (A.P.-R.)
| | - Carlos Palmeira
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal;
- Department of Life Sciences, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Joan Roselló-Catafau
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona (IIBB), CSIC-IDIBAPS, 08036 Barcelona, Spain; (R.G.B.); (R.T.d.S.); (E.F.-P.); (A.P.-R.)
- Correspondence:
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - René Adam
- AP-HP Hôpital Paul Brousse, UR, Chronothérapie, Cancers et Transplantation, Université Paris-Saclay, Villejuif, 91190 Paris, France;
| | - Arnau Panisello-Roselló
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona (IIBB), CSIC-IDIBAPS, 08036 Barcelona, Spain; (R.G.B.); (R.T.d.S.); (E.F.-P.); (A.P.-R.)
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