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https://www.readbyqxmd.com/read/29774176/pushing-the-limits-machine-preservation-of-the-liver-as-a-tool-to-recondition-high-risk-grafts
#1
REVIEW
Yuri L Boteon, Simon C Afford, Hynek Mergental
Purpose of the Review: Machine perfusion (MP) is a novel technology recently introduced in liver transplantation, redefining the current practice of organ preservation and pushing the limits of high-risk liver utilisation. This review highlights the key benefits of machine perfusion over conventional static cold storage (SCS), demonstrated in human liver research and clinical transplants. Recent Findings: The first clinical trials have demonstrated both safety and feasibility of MP...
2018: Current Transplantation Reports
https://www.readbyqxmd.com/read/29758129/twenty-four-hour-normothermic-perfusion-of-discarded-human-kidneys-with-urine-recirculation
#2
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 utilization and improved transplantation logistics. Eleven clinically-declined kidneys were perfused normothermically, six from donors after brain stem death (DBD, median cold ischemia time 33±36.9 hours) and five from donors after circulatory death (DCD, 36.2±38.3 hours): n=3 kidneys were perfused using Ringer's lactate to replace excreted urine volume, and n=8 using urine recirculation to maintain perfusate volume without fluid replenishment...
May 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29750566/advanced-age-results-in-a-diminished-endothelial-glycocalyx
#3
Daniel R Machin, Samuel I Bloom, Robert A Campbell, Tam T T Phuong, Phillip Ellis Gates, Lisa A Lesniewski, Matthew T Rondina, Anthony John Donato
Age-related microvascular dysfunction is well characterized in rodents and humans, but little is known about the properties of the microvascular endothelial glycocalyx in advanced age. We examined the glycocalyx in microvessels of young and old C57BL6 mice (young: 6.1{plus minus}0.1 vs old: 24.6{plus minus}0.2 mo) using intravital microscopy and transmission electron microscopy, and in human participants (young: 27{plus minus}1 vs old: 61{plus minus}2 yr) using intravital microscopy. Glycocalyx thickness in mesenteric and skeletal muscle microvessels was 51-54% lower in old, compared to young mice...
May 11, 2018: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/29746324/extracorporeal-perfusion-in-vascularized-composite-allotransplantation-current-concepts-and-future-prospects
#4
Maximilian Kueckelhaus, Flemming Puscz, Alexander Dermietzel, Mehran Dadras, Sebastian Fischer, Nicco Krezdorn, Bohdan Pomahac, Tobias Hirsch
Severe injuries of the face and limbs remain a major challenge in today's reconstructive surgery. Vascularized composite allotransplantation (VCA) has emerged as a promising approach to restore these defects. Yet, there are major obstacles preventing VCA from broad clinical application. Two key restrictions are (1) the graft's limited possible ischemia time, keeping the potential donor radius extremely small, and (2) the graft's immunogenicity, making extensive lifelong monitoring and immunosuppressive treatment mandatory...
June 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29744353/donation-after-circulatory-death-in-paediatric-liver-transplantation-current-status-and-future-perspectives-in-the-machine-perfusion-era
#5
REVIEW
Roberta Angelico, M Thamara P R Perera, Tommaso Maria Manzia, Alessandro Parente, Chiara Grimaldi, Marco Spada
Efforts have been made by the transplant community to expand the deceased donor pool in paediatric liver transplantation (LT). The growing experience on donation after circulatory death (DCD) for adult LT has encouraged its use also in children, albeit in selective cases, opening new perspectives for paediatric patients. Even though there has recently been a slight increase in the number of DCD livers transplanted in children, with satisfactory graft and patient outcomes, the use of DCD grafts in paediatric recipients is still controversial due to morbid outcomes associated with DCD grafts...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29744218/machine-perfusion-of-thoracic-organs
#6
REVIEW
Dirk Van Raemdonck, Filip Rega, Steffen Rex, Arne Neyrinck
This article summarizes recent knowledge and clinical advances in machine perfusion (MP) of thoracic organs. MP of thoracic organs has gained much attention during the last decade. Clinical studies are investigating the role of MP to preserve, resuscitate, and assess heart and lungs prior to transplantation. Currently, MP of the cardiac allograft is essential in all type DCD heart transplantation while MP of the pulmonary allograft is mandatory in uncontrolled DCD lung transplantation. MP of thoracic organs also offers an exciting platform to further investigate downregulation of the innate and adaptive immunity prior to reperfusion of the allograft in recipients...
April 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29731238/human-heart-transplantation-from-donation-after-circulatory-determined-death-donors-using-normothermic-regional-perfusion-and-cold-storage
#7
Simon Messer, Aravinda Page, Simon Colah, Richard Axell, Barbora Parizkova, Steven Tsui, Stephen Large
Heart transplantation from donation after circulatory-determined-death (DCD) donors is emerging as an additional avenue to increase heart transplant activity. Previous methods of DCD heart retrieval include direct procurement and cold storage, direct procurement, and machine perfusion and normothermic regional perfusion, followed by machine perfusion during transportation. Herein we report a further technique resulting in successful DCD heart transplantation utilizing normothermic regional perfusion and permitting functional assessment followed by cold storage...
March 30, 2018: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29730077/ex-vivo-normothermic-porcine-pancreas-a-physiological-model-for-preservation-and-transplant-study
#8
Rohan Kumar, Wen Yuan Chung, Franscois Runau, John David Isherwood, Kean Guan Kuan, Kevin West, Giuseppe Garcea, Ashley Robert Dennison
INTRODUCTION: An ex vivo normothermic porcine pancreas perfusion (ENPPP) model was established to investigate effects of machine perfusion pressures on graft preservation. METHODOLOGY: Nine porcine pancreata were perfused with autologous blood at 50 mmHg (control) pressure. Graft viability was compared against four ex-vivo porcine pancreata perfused at 20 mmHg ('low') pressure. Arterio-venous oxygen gas differentials, biochemistry, and graft insulin responses to glucose stimulation were compared...
May 3, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29713999/implications-of-electrocardiographic-frontal-qrs-axis-on-left-ventricular-diastolic-parameters-derived-from-electrocardiogram-gated-myocardial-perfusion-single-photon-emission-computed-tomography
#9
Satoshi Kurisu, Kazuhiro Nitta, Yoji Sumimoto, Hiroki Ikenaga, Ken Ishibashi, Yukihiro Fukuda, Yasuki Kihara
BACKGROUND: Current electrocardiographic (ECG) machines report various variables including frontal QRS axis automatically. We tested the hypothesis that QRS axis is associated with left ventricular (LV) diastolic parameters derived from ECG-gated myocardial perfusion single photon emission computed tomography (SPECT) independent of myocardial ischemia. METHODS: Ninety-three patients with preserved LV ejection fraction and no evidence of myocardial ischemia were enrolled based on ECG-gated SPECT...
April 30, 2018: Annals of Nuclear Medicine
https://www.readbyqxmd.com/read/29705279/effects-of-subnormothermic-perfusion-before-transplantation-for-liver-grafts-from-donation-after-cardiac-death-a-simplified-dripping-perfusion-method-in-pigs
#10
Y Kakizaki, S Miyagi, K Shimizu, H Kumata, M Matsumura, Y Miyazaki, K Fukuoka, S S Uematsu, K Tokodai, Y Hara, C Nakanishi, M Unno, T Kamei, M Goto
BACKGROUND: Liver transplantation from donors after cardiac death (DCD) provides a solution to the donor shortage. However, DCD liver grafts are associated with a high incidence of primary graft nonfunction. We investigated the effectiveness of subnormothermic porcine liver perfusion, before transplantation from DCD, on graft viability. METHODS: Landrace pigs (25-30 kg) were randomly allocated to 3 groups (5 per group): heart-beating (HB) graft, transplanted after a 4-hour period of cold storage (CS); DCD graft, retrieved 20 minutes after apnea-induced cardiac arrest (respiratory withdrawal) and transplanted after a 4-hour period of CS; and subnormothermic ex vivo liver perfusion (SELP) graft, retrieved in the same manner as the DCD graft but perfused with a subnormothermic oxygenated Krebs-Henseleit buffer (21-25°C, 10-15 cm H2 O) for 30 minutes in a simplified dripping manner, without a machine perfusion system, after the 4-hour period of CS, and subsequently transplanted...
April 25, 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29697462/ex-vivo-machine-perfusion-for-kidney-preservation
#11
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...
April 24, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29697165/automated-pixel-wise-brain-tissue-segmentation-of-diffusion-weighted-images-via-machine-learning
#12
Alexander Ciritsis, Andreas Boss, Cristina Rossi
The diffusion-weighted (DW) MR signal sampled over a wide range of b-values potentially allows for tissue differentiation in terms of cellularity, microstructure, perfusion, and T2 relaxivity. This study aimed to implement a machine learning algorithm for automatic brain tissue segmentation from DW-MRI datasets, and to determine the optimal sub-set of features for accurate segmentation. DWI was performed at 3 T in eight healthy volunteers using 15 b-values and 20 diffusion-encoding directions. The pixel-wise signal attenuation, as well as the trace and fractional anisotropy (FA) of the diffusion tensor, were used as features to train a support vector machine classifier for gray matter, white matter, and cerebrospinal fluid classes...
April 26, 2018: NMR in Biomedicine
https://www.readbyqxmd.com/read/29674604/does-ischemia-free-liver-procurement-under-normothermic-perfusion-benefit-the-outcome-of-liver-transplantation
#13
Qiang Zhao, Shanzhou Huang, Dongping Wang, Zhiheng Zhang, Linwei Wu, Lu Yang, Yi Ma, Fei Ji, Yunhua Tang, Linhe Wang, Zebin Zhu, Yanling Zhu, Wei Xiong, Maogen Chen, Ming Han, Jian Zhou, Anbin Hu, Guodong Wang, Xingyuan Jiao, Xiaofeng Zhu, Weiqiang Ju, Zhiyong Guo, Xiaoshun He
BACKGROUND In contrast to conventional static cold preservation, normothermic machine perfusion (NMP) provides a beneficial alternative preservation of donor livers. However, the liver still suffered cold ischemic injury before attaching to the perfusion device. MATERIAL AND METHODS To prevent cold ischemic injury during procurement, we describe a novel procedure called ischemia-free liver procurement (IFLP) under NMP. Two liver grafts were procured from brain death donor under NMP and underwent 2-hour ex vivo NMP followed by 3 and 6 hours of static cold preservation...
April 20, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29670285/a-randomized-trial-of-normothermic-preservation-in-liver-transplantation
#14
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...
April 18, 2018: Nature
https://www.readbyqxmd.com/read/29644030/proof-of-concept-liver-splitting-during-normothermic-machine-perfusion
#15
Barney T F Stephenson, Glenn K Bonney, Richard W Laing, Ricky H Bhogal, Francesca Marcon, Desley A H Neil, M Thamara P R Perera, Simon C Afford, Hynek Mergental, Darius F Mirza
Introduction: Despite utilizing extended criteria donors, there remains a shortage of livers for transplantation. No data exists on splitting donor livers with concurrent NMP-L. Methods: A liver recovered from a donor after circulatory death was subjected to NMP-L using a red cell based fluid. During NMP-L, a 'classical' left lateral + right trisegmentectomy split was performed using an integrated bipolar/ultrasonic device. After splitting, blood flow was confirmed using Doppler ultrasound in each lobe...
March 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29629996/normothermic-liver-preservation-current-status-and-future-directions
#16
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...
April 7, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29629796/advances-in-pancreatic-ct-imaging
#17
Renata R Almeida, Grace C Lo, Manuel Patino, Bernardo Bizzo, Rodrigo Canellas, Dushyant V Sahani
OBJECTIVE: The purpose of this article is to discuss the advances in CT acquisition and image postprocessing as they apply to imaging the pancreas and to conceptualize the role of radiogenomics and machine learning in pancreatic imaging. CONCLUSION: CT is the preferred imaging modality for assessment of pancreatic diseases. Recent advances in CT (dual-energy CT, CT perfusion, CT volumetry, and radiogenomics) and emerging computational algorithms (machine learning) have the potential to further increase the value of CT in pancreatic imaging...
April 9, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29609847/angiotensin-iv-improves-subnormothermic-machine-perfusion-preservation-of-rat-liver-graft
#18
Donia Tabka, Mohamed Bejaoui, James Javellaud, Jean-Michel Achard, Hassen Ben Abdennebi
This study aims to determine whether Angiotensin IV (Ang IV) addition to Celsior preservation solution could improve hepatic endothelium function and provide better liver protection during subnormothermic machine preservation (SMP). Two experimental models were used: In the first part of the study, rings isolated from rat hepatic artery were preserved in Celsior solution (6 h, 20 °C) with and without Ang IV (10-9  M), then, endothelium-dependent relaxation (EDR) and the concentration of acetylcholine inducing half-maximal relaxation of pre-contracted rings (EC50) were measured...
March 30, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29607529/transplantation-of-cold-stored-porcine-kidneys-after-controlled-oxygenated-rewarming
#19
Anja Gallinat, Jing Lu, Charlotte von Horn, Moritz Kaths, Marc Ingenwerth, Andreas Paul, Thomas Minor
The concept of "controlled oxygenated rewarming" (COR) using ex vivo machine perfusion after cold storage was evaluated as tool to improve renal graft function after transplantation. Renal function after 20 min warm ischemia and 21 h cold storage was studied in an auto-transplant model in pigs (25-30 kg, n = 6 per group). In the study group, preimplant ex vivo machine perfusion for 90 min was added after cold storage, including gentle warming up of the graft to 20°C (COR). Kidneys that were only cold stored for 21 h served as controls...
April 1, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29602202/renal-resistance-trend-during-hypothermic-machine-perfusion-is-more-predictive-of-postoperative-outcome-than-biopsy-score-preliminary-experience-in-35-consecutive-kidney-transplantations
#20
Massimiliano Bissolati, Paolo Giovanni Gazzetta, Rossana Caldara, Giovanni Guarneri, Olga Adamenko, Fabio Giannone, Michele Mazza, Giulia Maggi, Deborah Tomanin, Riccardo Rosati, Antonio Secchi, Carlo Socci
Hypothermic machine perfusion (HPM) grants a better postoperative outcome in transplantation of organs procured from extended criteria donors (ECDs) and donors after cardiac death (DCD). So far, the only available parameter for outcome prediction concerning those organs is pretransplant biopsy score. The aim of this study is to evaluate whether renal resistance (RR) trend during HPM may be used as a predictive marker for post-transplantation outcome. From December 2015 to present, HMP has been systematically applied to all organs from ECDs and DCD...
March 30, 2018: Artificial Organs
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