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Iwata H, Nakajo T, Kaneko H, Okazawa Y, Zin NKM, Bochimoto H, Ohashi M, Kawada Y, Kamikawa S, Kudo T, Okada Y, Ohara M, Obara H, Matsuno N. Combined Use of Subnormothermic Extracorporeal Support and Hypothermic Oxygenated Machine Perfusion for Liver Graft After Cardiac Death in Pigs. Transplant Proc 2023:S0041-1345(23)00133-1. [PMID: 37088618 DOI: 10.1016/j.transproceed.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. This study aims to determine the benefits of extracorporeal membrane oxygenation (ECMO) and hypothermic oxygenated machine perfusion (HOPE) in a large animal model of DCD liver. METHODS After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 45 minutes of cardiac death. Then, the livers were perfused for 4 hours by cold storage (CS) or HOPE. In group 1, non-in situ ECMO and grafts were preserved by HOPE. In group 2, in situ ECMO and grafts were preserved by HOPE. In group 3, in situ ECMO and grafts were preserved by CS. After preservation, all grafts were evaluated using an isolated reperfusion model (IRM) with autologous blood for 2 hours. RESULTS During HOPE, aspartate aminotransferase (AST) levels and hepatic arterial pressure in group 2 tended to be lower than in group 1. Hematoxylin-eosin staining findings after HOPE showed more massive sinusoidal congestion and hepatocyte cytoplasmic vacuolization in group 1 than in group 2. The AST and LDH levels in group 2 at the start-up of IRM tended to be lower than in group 1. CONCLUSIONS The combined use of in situ subnormothermic ECMO and HOPE is essential for the functional recovery of DCD liver grafts.
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Affiliation(s)
- Hiroyoshi Iwata
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tetsuya Nakajo
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroki Kaneko
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yuga Okazawa
- Department of Mechanical System Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Nur Khatijah Mohd Zin
- Department of Cell Physiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hiroki Bochimoto
- Department of Cell Physiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Makito Ohashi
- Department of Clinical Engineering, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Yoko Kawada
- Department of Clinical Engineering, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Shota Kamikawa
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takahiro Kudo
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yoko Okada
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Mizuho Ohara
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromichi Obara
- Department of Mechanical System Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan.
| | - Naoto Matsuno
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Gochi M, Kato F, Toriumi A, Kawagoe T, Yotsuya S, Ishii D, Otani M, Nishikawa Y, Furukawa H, Matsuno N. A Novel Preservation Solution Containing Quercetin and Sucrose for Porcine Kidney Transplantation. Transplant Direct 2020; 6:e624. [PMID: 33204822 PMCID: PMC7665254 DOI: 10.1097/txd.0000000000001077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 01/20/2023] Open
Abstract
In organ transplantation, the University of Wisconsin (UW) solution has been the gold standard for organ preservation. Quercetin (Que) has numerous antioxidant and anti-inflammatory activities, and sucrose (Suc) may be effective for cold storage (CS). This study aimed to investigate the in vitro protective effect of Que and Suc on cold injury to the kidney and to determine whether Que + Suc could improve ischemia-reperfusion injury during CS and hypothermic oxygenated perfusion (HOPE) in autologous transplantation models. METHODS BHK-21 cells were stored at 4°C for 3 days in UW solution for CS/machine perfusion (CS/MP-UW) with Que (33.1 μM, 3.3 μM, 0.33 μM) and Suc (0.1 M). In a porcine model of renal autologous transplantation, left kidney grafts were preserved under 3 conditions: group 1, CS preservation for 24 hours; group 2, CS preservation for 22 hours and HOPE with CS/MP-UW solution for 2 hours; and group 3, identical preservation as group 2, with Que and Suc added to the solution. Animals were euthanized on day 7 after autologous transplantation. RESULTS After 3 days of CS preservation, the CS/MP-UW solution with Que (33.1 μM, 3.3 μM) and Suc showed significant cell protection against cold injury. In the porcine model of renal autologous transplantation, the last blood Cre level and the blood lipid hydroperoxide on posttransplantation day 2 were significantly different between group 1 and group 3. Moreover, the total endothelial, glomerular, tubular, interstitial (EGTI) histology score in the kidney tissue was also significantly different. Regarding the change in renal resistance in HOPE, the decrease observed in group 3 was significantly larger than that in group 2. CONCLUSIONS Our results suggest that the addition of Que and Suc to a UW solution can improve kidney preservation and could potentially enhance the outcome of kidney transplantation.
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Affiliation(s)
- Mikako Gochi
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Fuminori Kato
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Asuka Toriumi
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Tomoko Kawagoe
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Shuichi Yotsuya
- Pharmaceutical Development Division, Life Science Business Development Headquarters, Ishihara Sangyo Kaisha, Ltd., Osaka, Japan
| | - Daisuke Ishii
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Masahide Otani
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
| | - Yuji Nishikawa
- Department of Pathology, Asahikawa Medical University, Hokkaido, Japan
| | - Hiroyuki Furukawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Naoto Matsuno
- Department of Transplantation Technology and Therapeutic Development, Asahikawa Medical University, Hokkaido, Japan
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Shonaka T, Matsuno N, Obara H, Yoshikawa R, Nishikawa Y, Ishihara Y, Bochimoto H, Gochi M, Otani M, Kanazawa H, Azuma H, Sakai H, Furukawa H. Impact of human-derived hemoglobin based oxygen vesicles as a machine perfusion solution for liver donation after cardiac death in a pig model. PLoS One 2019; 14:e0226183. [PMID: 31825976 PMCID: PMC6905570 DOI: 10.1371/journal.pone.0226183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The recent clinical application of perfusion technology for the machine preservation of donation after cardiac death (DCD) grafts has some advantages. Oxygenation has been proposed for the preservation of DCD liver grafts. The aim of this study is to clarify whether the use of HbV-containing preservation solution during the subnormothermic machine perfusion (SNMP) of the liver graft improves the graft function of DCD porcine livers in an ex vivo reperfusion model. Pig livers were excised after 60 minutes of warm ischemic time and were preserved under one of three preservation conditions for 4 hours. The preservation conditions were as follows: 4°C cold storage (CS group; N = 5), Hypothermic machine preservation (HMP) with UW gluconate solution (HMP group; N = 5), SNMP (21°C) with UW gluconate solution (SNMP group; N = 5), SNMP (21°C) with HbVs (Hb; 1.8 mg/dl) perfusate (SNMP+HbV group; N = 5). Autologous blood perfusion was performed for 2 hours in an isolated liver reperfusion model (IRM). The oxygen consumption of the SNMP and SNMP+HbV group was higher than the HMP groups (p < 0.05). During the reperfusion, the AST level in the SNMP+HbV group was lower than that in the CS, HMP and SNMP groups. The changes in pH after reperfusion was significantly lower in SNMP+HbV group than CS and HMP groups. The ultrastructural findings indicated that the mitochondria of the SNMP+HbV group was well maintained in comparison to the CS, HMP and SNMP groups. The SNMP+HbVs preservation solution protected against metabolic acidosis and preserved the liver function after reperfusion injury in the DCD liver.
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Affiliation(s)
- Tatsuya Shonaka
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Naoto Matsuno
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Hiromichi Obara
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji-shi, Tokyo, Japan
| | - Ryo Yoshikawa
- Department of Mechanical Engineering, Tokyo Metropolitan University, Hachioji-shi, Tokyo, Japan
| | - Yuji Nishikawa
- Department of Pathology, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Yo Ishihara
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Hiroki Bochimoto
- Department of Cell Physiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Mikako Gochi
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Masahide Otani
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Hiroyuki Kanazawa
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
| | - Hiromi Sakai
- Department of Chemistry, Nara Medical University, Kashihara-shi, Nara, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, Asahikawa-shi, Hokkaido, Japan
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Morito N, Obara H, Matsuno N, Enosawa S, Furukawa H. Oxygen consumption during hypothermic and subnormothermic machine perfusions of porcine liver grafts after cardiac death. J Artif Organs 2018; 21:450-457. [DOI: 10.1007/s10047-018-1063-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
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Regulated Oxygenation of Rewarming Machine Perfusion for Porcine Donation After Cardiac Death Liver Transplantation. Transplant Proc 2016; 48:1244-6. [DOI: 10.1016/j.transproceed.2015.12.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/30/2015] [Indexed: 01/31/2023]
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