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Viability assessment machine perfusion

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https://www.readbyqxmd.com/read/29887782/the-role-of-normothermic-perfusion-in-liver-transplantation-transit-study-a-systematic-review-of-preliminary-studies
#1
REVIEW
Kumar Jayant, Isabella Reccia, Francesco Virdis, A M James Shapiro
Introduction: The success of liver transplantation has been limited by the unavailability of suitable donor livers. The current organ preservation technique, i.e., static cold storage (SCS), is not suitable for marginal organs. Alternatively, normothermic machine perfusion (NMP) promises to recreate the physiological environment and hence holds promise for the better organ preservation. The objective of this systematic review is to provide an overview of the safety, benefits, and insight into the other potential useful parameters of NMP in the liver preservation...
2018: HPB Surgery: a World Journal of Hepatic, Pancreatic and Biliary Surgery
https://www.readbyqxmd.com/read/29791060/implementing-an-innovated-preservation-technology-the-american-society-of-transplant-surgeons-asts-standards-committee-white-paper-on-ex-situ-liver-machine-perfusion
#2
Cristiano Quintini, Paulo N Martins, Shimul Shah, Mary Killackey, Alan Reed, James Guarrera, David A Axelrod
The pervasive shortage of deceased donor liver allografts contributes to significant waitlist mortality despite efforts to increase organ donation. Ex vivo liver perfusion appears to enhance preservation of donor organs, extending viability and potentially evaluating function in organs previously considered too high risk for transplant. These devices pose novel challenges for organ allocation, safety, training, and finances. This white paper describes the American Society of Transplant Surgeons' belief that organ preservation technology is a vital advance, but its use should not change fundamental aspects of organ allocation...
May 23, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29758129/twenty-four-hour-normothermic-perfusion-of-discarded-human-kidneys-with-urine-recirculation
#3
Annemarie Weissenbacher, Letizia Lo Faro, Olga Boubriak, Maria F Soares, Ian S Roberts, James P Hunter, Daniel Voyce, Nikolay Mikov, Andrew Cook, Rutger J Ploeg, Constantin C Coussios, Peter J Friend
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ use, and improved transplant logistics. Eleven clinically declined kidneys were perfused normothermically, with 6 being from donors after brain death (median cold ischemia time 33 ± 36.9 hours) and 5 being from donors after circulatory death (36.2 ± 38.3 hours). Three kidneys were perfused using Ringer's lactate to replace excreted urine volume, and 8 kidneys were perfused using urine recirculation to maintain perfusate volume without fluid replenishment...
May 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29697462/ex-vivo-machine-perfusion-for-kidney-preservation
#4
Matyas Hamar, Markus Selzner
PURPOSE OF REVIEW: Machine perfusion is a novel strategy to decrease preservation injury, improve graft assessment, and increase organ acceptance for transplantation. This review summarizes the current advances in ex-vivo machine-based kidney preservation technologies over the last year. RECENT FINDINGS: Ex-vivo perfusion technologies, such as hypothermic and normothermic machine perfusion and controlled oxygenated rewarming, have gained high interest in the field of organ preservation...
June 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29670285/a-randomized-trial-of-normothermic-preservation-in-liver-transplantation
#5
David Nasralla, Constantin C Coussios, Hynek Mergental, M Zeeshan Akhtar, Andrew J Butler, Carlo D L Ceresa, Virginia Chiocchia, Susan J Dutton, Juan Carlos García-Valdecasas, Nigel Heaton, Charles Imber, Wayel Jassem, Ina Jochmans, John Karani, Simon R Knight, Peri Kocabayoglu, Massimo Malagò, Darius Mirza, Peter J Morris, Arvind Pallan, Andreas Paul, Mihai Pavel, M Thamara P R Perera, Jacques Pirenne, Reena Ravikumar, Leslie Russell, Sara Upponi, Chris J E Watson, Annemarie Weissenbacher, Rutger J Ploeg, Peter J Friend
Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time...
May 2018: Nature
https://www.readbyqxmd.com/read/29629996/normothermic-liver-preservation-current-status-and-future-directions
#6
Danielle Detelich, James F Markmann
PURPOSE OF REVIEW: Normothermic machine perfusion (NMP) is an emerging technology for liver preservation. Early clinical results demonstrate beneficial effects in reconditioning high-risk grafts. This review discusses the role of normothermic perfusion as a tool to assess graft viability and as a platform for graft intervention and modification. RECENT FINDINGS: The potential benefits of NMP extend far beyond organ reconditioning. Recent pilot studies have identified clinically relevant viability criteria, which now require validation in large randomized control trials prior to implementation...
June 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29566990/preserving-and-perfusing-the-allograft-pancreas-past-present-and-future
#7
REVIEW
Shamik Dholakia, Elisabeth Royston, Edward J Sharples, Visesh Sankaran, Rutger J Ploeg, Peter J Friend
The concept of organ preservation by perfusion dates back to the mid-19th century. Innovations since then have included temperature regulation, perfusion fluid composition and various pumping systems. Advances made in liver, heart and kidney machine preservation are now contributing to increased graft utilisation, assessment of graft viability and potentially improved graft survival. Pancreas transplantation has not benefitted to the same extent from the application of perfusion technology, although the need is just as great...
March 6, 2018: Transplantation Reviews
https://www.readbyqxmd.com/read/29564207/normothermic-machine-preservation-of-the-liver-state-of-the-art
#8
REVIEW
Carlo D L Ceresa, David Nasralla, Wayel Jassem
Purpose of Review: This review aims to introduce the concept of normothermic machine perfusion (NMP) and its role in liver transplantation. By discussing results from recent clinical studies and highlighting the potential opportunities provided by this technology, we aim to provide a greater insight into NMP and the role it can play to enhance liver transplantation. Recent Findings: NMP has recently been shown to be both safe and feasible in liver transplantation and has also demonstrated its superiority to traditional cold storage in terms of early biochemical liver function...
2018: Current Transplantation Reports
https://www.readbyqxmd.com/read/29564205/from-gut-feeling-to-objectivity-machine-preservation-of-the-liver-as-a-tool-to-assess-organ-viability
#9
REVIEW
Christopher J E Watson, Ina Jochmans
Purpose of Review: The purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers. Recent Findings: In both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo...
2018: Current Transplantation Reports
https://www.readbyqxmd.com/read/29325720/development-of-pancreatic-machine-perfusion-translational-steps-from-porcine-to-human-models
#10
Karim Hamaoui, Sally Gowers, Bynvant Sandhu, Natalie Vallant, Terry Cook, Martyn Boutelle, Daniel Casanova, Vassilios Papalois
BACKGROUND: Hypothermic machine perfusion (HMP) is increasingly being used for extended criteria kidney grafts. Pancreatic HMP is challenging because physiologically the pancreas is a low-flow organ susceptible to edema. We report the successful development of preclinical HMP models using porcine pancreases, as well as human pancreases unsuitable for clinical transplantation. METHODS: Ten porcine pancreases were used in the development of these perfusion models...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29324518/the-dawn-of-liver-perfusion-machines
#11
Danielle Detelich, James F Markmann
PURPOSE OF REVIEW: Despite high demand, a severe shortage of suitable allografts limits the use of liver transplantation for the treatment of end-stage liver disease. The transplant community is turning to the utilization of high-risk grafts to fill the void. This review summarizes the reemergence of ex-vivo machine perfusion for liver graft preservation, including results of recent clinical trials and its specific role for reconditioning DCD, steatotic and elderly grafts. RECENT FINDINGS: Several phase-1 clinical trials demonstrate the safety and feasibility of machine perfusion for liver graft preservation...
April 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29281862/normothermic-machine-perfusion-of-donor-livers-without-the-need-for-human-blood-products
#12
Alix P M Matton, Laura C Burlage, Rianne van Rijn, Yvonne de Vries, Shanice A Karangwa, Maarten W Nijsten, Annette S H Gouw, Janneke Wiersema-Buist, Jelle Adelmeijer, Andrie C Westerkamp, Ton Lisman, Robert J Porte
Normothermic machine perfusion (NMP) enables viability assessment of donor livers prior to transplantation. NMP is frequently performed by using human blood products including red blood cells (RBCs) and fresh frozen plasma (FFP). Our aim was to examine the efficacy of a novel machine perfusion solution based on polymerized bovine hemoglobin-based oxygen carrier (HBOC)-201. Twenty-four livers declined for transplantation were transported by using static cold storage. Upon arrival, livers underwent NMP for 6 hours using pressure-controlled portal and arterial perfusion...
April 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29176869/successful-transplantation-of-porcine-liver-grafts-following-48-hour-normothermic-preservation
#13
Thomas Vogel, Jens G Brockmann, David Pigott, Desley A H Neil, Anand S Rathnasamy Muthusamy, Constantin C Coussios, Peter J Friend
Current cold storage organ preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation of liver allografts. Long-term organ preservation using normothermic perfusion might not only allow organ viability assessment before transplantation, but also provide the means for further organ modifications under physiologic conditions. Previous research has shown that porcine livers can be transplanted successfully after normothermic preservation of 20 hours...
2017: PloS One
https://www.readbyqxmd.com/read/28901972/normothermic-machine-perfusion-of-the-kidney
#14
REVIEW
Annemarie Weissenbacher, James Hunter
PURPOSE OF REVIEW: Normothermic machine perfusion (NMP) is a preservation method that is generating increasing interest. The aim of this review is to summarise the current status of NMP in regards of kidney viability assessment, reducing organ damage and improving transplant logistics. RECENT FINDINGS: The results of recent large animal experiments and clinical trials show that continuous prolonged normothermic ex-vivo kidney perfusion appears better than a brief period of NMP after static cold storage in terms of renal injury and function...
December 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28624105/hypo-and-normothermic-perfusion-of-the-liver-which-way-to-go
#15
REVIEW
Jasmijn Selten, Andrea Schlegel, Jeroen de Jonge, Philipp Dutkowski
The demand of donor livers for transplantation exceeds the supply. In an attempt to maximize the number of potentially usable donor livers, several centers are exploring the role of machine perfusion. This review provides an update on machine perfusion strategies and basic concepts, based on current clinical issues, and discuss challenges, including currently used biomarkers for assessing the quality and viability of perfused organs. The potential benefits of machine perfusion on immunogenicity and the consequences on post-operative immunosuppression management are discussed...
April 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28351756/oxygenated-hypothermic-machine-perfusion-after-static-cold-storage-improves-endothelial-function-of-extended-criteria-donor-livers
#16
Laura C Burlage, Negin Karimian, Andrie C Westerkamp, Nienke Visser, Alix P M Matton, Rianne van Rijn, Jelle Adelmeijer, Janneke Wiersema-Buist, Annette S H Gouw, Ton Lisman, Robert J Porte
BACKGROUND: Lack of oxygen and biomechanical stimulation during static cold storage (SCS) of donor livers compromises endothelial cell function. We investigated the effect of end-ischemic oxygenated hypothermic machine perfusion (HMP) on endothelial cell function of extended criteria donor (ECD) livers. METHODS: Eighteen livers, declined for transplantation, were transported to our center using static cold storage (SCS). After SCS, 6 livers underwent two hours of HMP, and subsequent normothermic machine perfusion (NMP) to assess viability...
June 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28333889/normothermic-ex-situ-liver-preservation-the-new-gold-standard
#17
REVIEW
Richard W Laing, Hynek Mergental, Darius F Mirza
PURPOSE OF REVIEW: Normothermic machine perfusion of the liver (NMP-L) is a novel technology recently introduced into the practice of liver transplantation. This review recapitulates benefits of normothermic perfusion over conventional static cold storage and summarizes recent publications in this area. RECENT FINDINGS: The first clinical trials have demonstrated both safety and feasibility of NMP-L. They have shown that machine perfusion can entirely replace cold storage or be commenced following a period of cold ischaemia...
June 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301388/cold-storage-or-normothermic-perfusion-for-liver-transplantation-probable-application-and-indications
#18
REVIEW
Carlo D L Ceresa, David Nasralla, Simon Knight, Peter J Friend
PURPOSE OF REVIEW: Preservation of the liver via normothermic machine perfusion (NMP) is rapidly becoming an area of great academic and clinical interest. This review focuses on the benefits and limitations of NMP and where the role for static cold storage may lie. RECENT FINDINGS: Clinical studies have recently been published reporting the use of NMP in liver preservation for transplantation. They have described the technology to be well tolerated and feasible with potentially improved posttransplant outcomes...
June 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/27993213/an-ex%C3%A2-vivo-comparison-of-adenosine-and-lidocaine-solution-and-university-of-wisconsin-solution-for-hypothermic-machine-perfusion-of-porcine-kidneys-potential-for-development
#19
COMPARATIVE STUDY
Karim Hamaoui, Adeel Aftab, Sally Gowers, Martyn Boutelle, Terry Cook, Donna Rudd, Geoffrey P Dobson, Vassilios Papalois
BACKGROUND: The optimal hypothermic machine perfusion (HMP) solution has not yet been developed. An adenosine and lidocaine (AL) solution has been shown to be protective in cardiac preservation. The aim of the present study was to examine a modified AL solution with low Ca(2+), 16 mM Mg(2+), and 4% albumin on kidney preservation compared with University Wisconsin solution (UW). METHODS: Twenty donation of organs after cardiac death porcine kidneys underwent HMP for 10 h (AL, n = 10; UW, n = 10) and then 2 h of normothermic reperfusion...
February 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27941437/activation-of-fibrinolysis-but-not-coagulation-during-end-ischemic-ex-situ-normothermic-machine-perfusion-of-human-donor-livers
#20
Shanice A Karangwa, Laura C Burlage, Jelle Adelmeijer, Negin Karimian, Andrie C Westerkamp, Alix P Matton, Rianne van Rijn, Janneke Wiersema-Buist, Micheal E Sutton, Sanna Op den Dries, Ton Lisman, Robert J Porte
BACKGROUND: Ex situ normothermic machine perfusion (NMP) can be performed after traditional static cold preservation to assess graft function and viability before transplantation. It is unknown whether this results in activation of coagulation and fibrinolysis, as may occur upon graft reperfusion in vivo. METHODS: Twelve donor livers declined for transplantation underwent 6 hours of end-ischemic NMP using a heparinized plasma-based perfusion fluid. Concentration of prothrombin fragment F1 + 2 (marker of coagulation activation), D-dimer, plasmin-antiplasmin complex, tissue plasminogen activator and plasminogen activator inhibitor-1 (markers for fibrinolysis) and alanine aminotransferase (ALT) (marker of ischemia-reperfusion [I/R] injury) were measured in perfusion fluid at regular intervals...
February 2017: Transplantation
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