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Viability assessment machine perfusion

M Hagiwara, N Matsuno, L T Meng, M Furukori, K Watanabe, T Shonaka, K Imai, H Obara, Y Nishikawa, H Furukawa
BACKGROUND: The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. The objective of this study is to determine the benefits of extracorporeal membrane oxygenation (ECMO) and subnormothermic machine perfusion (MP) with rewarming 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 60 minutes of cardiac death...
May 2016: Transplantation Proceedings
H Mergental, M T P R Perera, R W Laing, P Muiesan, J R Isaac, A Smith, B T F Stephenson, H Cilliers, D A H Neil, S G Hübscher, S C Afford, D F Mirza
The demand for liver transplantation (LT) exceeds supply, with rising waiting list mortality. Utilization of high-risk organs is low and a substantial number of procured livers are discarded. We report the first series of five transplants with rejected livers following viability assessment by normothermic machine perfusion of the liver (NMP-L). The evaluation protocol consisted of perfusate lactate, bile production, vascular flows, and liver appearance. All livers were exposed to a variable period of static cold storage prior to commencing NMP-L...
May 19, 2016: American Journal of Transplantation
I Jochmans, M Z Akhtar, D Nasralla, P Kocabayoglu, C Boffa, M Kaisar, A Brat, J O'Callaghan, L H M Pengel, S Knight, R J Ploeg
The increased demand for organs has led to the increased usage of "higher risk" kidney and liver grafts. These grafts from donation after circulatory death or expanded criteria donors are more susceptible to preservation injury and have a higher risk of unfavorable outcomes. Dynamic, instead of static, preservation could allow for organ optimization, offering a platform for viability assessment, active organ repair and resuscitation. Ex situ machine perfusion and in situ regional perfusion in the donor are emerging as potential tools to preserve and resuscitate vulnerable grafts...
September 2016: American Journal of Transplantation
Julie De Deken, Peri Kocabayoglu, Cyril Moers
PURPOSE OF REVIEW: This article summarizes novel developments in hypothermic machine perfusion (HMP) as an organ preservation modality for kidneys recovered from deceased donors. RECENT FINDINGS: HMP has undergone a renaissance in recent years. This renewed interest has arisen parallel to a shift in paradigms; not only optimal preservation of an often marginal quality graft is required, but also improved graft function and tools to predict the latter are expected from HMP...
June 2016: Current Opinion in Organ Transplantation
Karim Hamaoui, Sally Gowers, Samir Damji, Michelle Rogers, Chi Leng Leong, George Hanna, Ara Darzi, Martyn Boutelle, Vassilios Papalois
BACKGROUND: Viability assessment during preservation is imperative to avoid unnecessary discard of marginal organs maximizing graft outcomes in kidney transplantation. To address this need, we have developed a novel system based on a rapid sampling microdialysis (rsMD) analyzer allowing continuous tissue monitoring and measurement of metabolic markers of cell damage. Our aim was to develop a tool that allows for accurate assessment of tissue metabolism and organ viability in the preservation period...
January 2016: Journal of Surgical Research
Aukje Brat, Robert A Pol, Henri G D Leuvenink
PURPOSE OF REVIEW: The purpose of this review was to summarize the novel developments in preservation of older kidneys. RECENT FINDINGS: The importance of older donors as a source of renal grafts is increasing, with a concomitant increase of posttransplant failure. Preservation of kidneys retrieved from older donors through hypothermic machine perfusion reduces delayed graft function rate and increases long-term graft survival. Assessment of renal function and selection through biomarkers or perfusion criteria to predict posttransplant function are limited...
August 2015: Current Opinion in Organ Transplantation
Andrie C Westerkamp, Paria Mahboub, Sophie L Meyer, Maximilia Hottenrott, Petra J Ottens, Janneke Wiersema-Buist, Annette S H Gouw, Ton Lisman, Henri G D Leuvenink, Robert J Porte
A short period of oxygenated machine perfusion (MP) after static cold storage (SCS) may reduce biliary injury in donation after cardiac death (DCD) donor livers. However, the ideal perfusion temperature for protection of the bile ducts is unknown. In this study, the optimal perfusion temperature for protection of the bile ducts was assessed. DCD rat livers were preserved by SCS for 6 hours. Thereafter, 1 hour of oxygenated MP was performed using either hypothermic machine perfusion, subnormothermic machine perfusion, or with controlled oxygenated rewarming (COR) conditions...
October 2015: Liver Transplantation
Negin Karimian, Alix P M Matton, Andrie C Westerkamp, Laura C Burlage, Sanna Op den Dries, Henri G D Leuvenink, Ton Lisman, Korkut Uygun, James F Markmann, Robert J Porte
In contrast to conventional static cold preservation (0-4 °C), ex situ machine perfusion may provide better preservation of donor livers. Continuous perfusion of organs provides the opportunity to improve organ quality and allows ex situ viability assessment of donor livers prior to transplantation. This video article provides a step by step protocol for ex situ normothermic machine perfusion (37 °C) of human donor livers using a device that provides a pressure and temperature controlled pulsatile perfusion of the hepatic artery and continuous perfusion of the portal vein...
2015: Journal of Visualized Experiments: JoVE
Reena Ravikumar, Henri Leuvenink, Peter J Friend
Despite increasing donor numbers, waiting lists and pre-transplant mortality continue to grow in many countries. The number of donor organs suitable for liver transplantation is restricted by cold preservation and ischemia-reperfusion injury (IRI). Transplantation of marginal donor organs has led to renewed interest in new techniques which have the potential to improve the quality of preservation, assess the quality of the organ and allow repair of the donor organ prior to transplantation. If successful, such techniques would not only improve the outcome of currently transplanted marginal livers, but also increase the donor pool...
June 2015: Transplant International: Official Journal of the European Society for Organ Transplantation
Herman Tolboom, Veronika Olejníčková, Diana Reser, Barbara Rosser, Markus J Wilhelm, Max Gassmann, Anna Bogdanova, Volkmar Falk
OBJECTIVES: To establish the optimal machine perfusion temperature for recovery of hearts in a rodent model of donation after declaration of cardiocirculatory death (DCD). METHODS: Hearts from male Lewis rats (n = 14/group) were subjected to 25 min of in situ warm (37°C) ischaemia to simulate DCD. They were then explanted and reperfused with diluted autologous blood for 60 min at 20, 25, 30, 33 or 37°C, after which they were stored at 0-4°C in Custodiol preservation solution for 240 min...
January 2016: European Journal of Cardio-thoracic Surgery
V Gómez, A Orosa, M Rivera, V Diez-Nicolás, V Hevia, S Alvarez, D Carracedo, E Ramos, F J Burgos
BACKGROUND: Donor shortage necessitates the development of tools capable of objectively assessing kidney graft quality from expanded criteria donors and kidneys donated after cardiac death. The deteriorating donor profile is leading to a shift from cold storage toward machine perfusion preservation. Several authors found that renal resistance (RR) at the end of machine perfusion was an independent risk factor for the development of delayed graft function (DGF). In contrast, Doppler ultrasonography in the posttransplant period reveals renal hemodynamics and is useful in diagnosing renal allograft dysfunction...
January 2015: Transplantation Proceedings
Ina Jochmans, John M O'Callaghan, Jacques Pirenne, Rutger J Ploeg
Hypothermic machine perfusion (HMP) of kidneys is a long-established alternative to static cold storage and has been suggested to be a better preservation method. Today, as our deceased donor profile continues to change towards higher-risk kidneys of lower quality, we are confronted with the limits of cold storage. Interest in HMP as a preservation technique is on the rise. Furthermore, HMP also creates a window of opportunity during which to assess the viability and quality of the graft before transplantation...
June 2015: Transplant International: Official Journal of the European Society for Organ Transplantation
Michael E Sutton, Sanna op den Dries, Negin Karimian, Pepijn D Weeder, Marieke T de Boer, Janneke Wiersema-Buist, Annette S H Gouw, Henri G D Leuvenink, Ton Lisman, Robert J Porte
Although normothermic machine perfusion of donor livers may allow assessment of graft viability prior to transplantation, there are currently no data on what would be a good parameter of graft viability. To determine whether bile production is a suitable biomarker that can be used to discriminate viable from non-viable livers we have studied functional performance as well as biochemical and histological evidence of hepatobiliary injury during ex vivo normothermic machine perfusion of human donor livers. After a median duration of cold storage of 6...
2014: PloS One
Alison J Guy, Jay Nath, Mark Cobbold, Christian Ludwig, Daniel A Tennant, Nicholas G Inston, Andrew R Ready
BACKGROUND: The metabolic processes occurring within the preserved kidney during hypothermic machine perfusion (HMP) are not well characterized. The aim of this study was to use nuclear magnetic resonance (NMR) spectroscopy to examine the metabolomic profile of HMP perfusate from human cadaveric kidneys awaiting transplantation and to identify possible discriminators between the profiles of kidneys with delayed graft function (DGF) and immediate graft function (IGF). METHODS: Perfusates from HMP kidneys were sampled at 45 min and 4 hr of preservation with the LifePort Kidney Transporter 1...
April 2015: Transplantation
Cornelia J Verhoeven, Waqar R R Farid, Jeroen de Jonge, Herold J Metselaar, Geert Kazemier, Luc J W van der Laan
A global rising organ shortage necessitates the use of extended criteria donors (ECD) for liver transplantation (LT). However, poor preservation and extensive ischemic injury of ECD grafts have been recognized as important factors associated with primary non-function, early allograft dysfunction, and biliary complications after LT. In order to prevent for these ischemia-related complications, machine perfusion (MP) has gained interest as a technique to optimize preservation of grafts and to provide the opportunity to assess graft quality by screening for extensive ischemic injury...
September 2014: Journal of Hepatology
Herman Tolboom, Asya Makhro, Barbara A Rosser, Markus J Wilhelm, Anna Bogdanova, Volkmar Falk
OBJECTIVES: A severe donor organ shortage leads to the death of a substantial number of patients who are listed for transplantation. The use of hearts from donors after circulatory death could significantly expand the donor organ pool, but due to concerns about their viability, these are currently not used for transplantation. We propose short-term ex vivo normothermic machine perfusion (MP) to improve the viability of these ischaemic donor hearts. METHODS: Hearts from male Lewis rats were subjected to 25 min of global in situ warm ischaemia (WI) (37°C), explanted, reconditioned for 60 min with normothermic (37°C) MP with diluted autologous blood and then stored for 4 h at 0-4°C in Custodiol cold preservation solution...
January 2015: European Journal of Cardio-thoracic Surgery
Sarah A Hosgood, Ernest van Heurn, Michael L Nicholson
Kidney transplantation is limited by hypothermic preservation techniques. Prolonged periods of cold ischaemia increase the risk of early graft dysfunction and reduce long-term survival. To extend the boundaries of transplantation and utilize kidneys from more marginal donors, improved methods of preservation are required. Normothermic perfusion restores energy levels in the kidney allowing renal function to be restored ex vivo. This has several advantages: cold ischaemic injury can be avoided or minimized, the kidney can be maintained in a stable state allowing close observation and assessment of viability and lastly, it provides the ideal opportunity to add therapies to directly manipulate and improve the condition of the kidney...
June 2015: Transplant International: Official Journal of the European Society for Organ Transplantation
Anna J Dare, Gavin J Pettigrew, Kourosh Saeb-Parsy
Variation in deceased-donor kidney quality can significantly affect outcomes after kidney transplantation. Suboptimal organ selection for a given recipient can result in primary nonfunction, premature graft failure, or inappropriate discard of a suitable organ. Appraisal and appropriate selection of deceased-donor kidneys for use in transplantation is therefore critical. A number of predictive tools have been developed to assist the transplant team in evaluating the suitability of a deceased-donor kidney for transplantation to a given recipient...
April 27, 2014: Transplantation
Jean-Bernard Buchs, Leo Buehler, Solange Moll, Raphael Ruttimann, Antonio Nastasi, Jeffrey Kasten, Philippe Morel, François Lazeyras
BACKGROUND: Magnetic resonance imaging (MRI) gadolinium-perfusion was applied in simulated Donation after Cardiac Death (DCD) in porcine kidneys to measure intrarenal perfusion. Adenosine triphosphate (ATP) resynthesis during oxygenated hypothermic perfusion was compared to evaluate the "ex vivo organ viability". Adenine nucleotide (AN) was measured by P nuclear magnetic resonance (NMR) spectroscopy. Whereas this latter technique requires sophisticated hardware, gadolinium-perfusion can be realized using any standard proton-MRI scanner...
January 27, 2014: Transplantation
Leonid Bunegin, Gleb P Tolstykh, Jerry F Gelineau, A Benedict Cosimi, Lisa M Anderson
Hypothermic machine perfusion (HMP) for the preservation of kidneys, recovered from extended criteria organ donors (ECDs), presents the opportunity for assessing ex vivo parameters that may have value in predicting postimplantation organ viability. Organ perfusion and vascular resistance are the parameters most frequently cited as the basis for the decision to use or discard a donor kidney. The limitation of these measures is emphasized by the observation that a significant percentage of ECD kidneys with poor perfusion parameters can provide life-sustaining function after transplantation...
July 2013: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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