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normothermic machine perfusion

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https://www.readbyqxmd.com/read/28301388/cold-storage-or-normothermic-perfusion-for-liver-transplantation-probable-application-and-indications
#1
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...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301386/kidney-perfusion-some-like-it-hot-others-prefer-to-keep-it-cool
#2
Ina Jochmans, Michael L Nicholson, Sarah A Hosgood
PURPOSE OF REVIEW: Machine perfusion technologies provide an opportunity for improved preservation, organ assessment, and resuscitation of damaged kidneys. This review summarizes the recent advances in hypothermic and normothermic kidney machine perfusion technologies. RECENT FINDINGS: Modifications to the perfusion conditions with the addition of oxygen during hypothermic machine perfusion can support a low level of metabolism, which in experimental settings improves graft function...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28240817/liver-ex-vivo-machine-perfusion-preservation-a-review-of-the-methodology-and-results-of-large-animal-studies-and-clinical-trials
#3
REVIEW
Hazel Marecki, Adel Bozorgzadeh, Robert Porte, Henri Leuvenink, Korkut Uygun, Paulo Martins
Ex-vivo machine perfusion is a promising way to better preserve livers prior to transplantation. Currently, no methodology has verified benefit over simple cold storage. Before becoming clinically feasible, machine perfusion requires validation in models that reliably predict human performance. Such a model has been found in porcine liver, who's physiological, anatomical, and immunological characteristics closely resemble the human liver. Since the 1930s, researchers have explored machine perfusion as preservation, but only recently have clinical trials been performed...
February 27, 2017: Liver 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
#4
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/27941468/liver-perfusion-devices-how-close-are-we-to-widespread-application
#5
Amelia J Hessheimer, Constantino Fondevila
PURPOSE OF REVIEW: Ex-situ liver machine perfusion has been the focus of increasing interest over the past decade as a means to improve the quality of livers for transplantation and the applicability of liver transplantation in general. The present review aims to evaluate the experimental basis for liver machine perfusion and the significance of recent reports on its clinical application. RECENT FINDINGS: Although liver machine perfusion has been studied experimentally over a range of temperatures, clinical liver transplant work that has been performed to date has been done using either hypothermic machine perfusion (0-12 °C), HMP or normothermic machine perfusion (35-38 °C, NMP)...
December 9, 2016: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/27941437/activation-of-fibrinolysis-but-not-coagulation-during-end-ischemic-ex-situ-normothermic-machine-perfusion-of-human-donor-livers
#6
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
https://www.readbyqxmd.com/read/27870928/mir-182-5p-inhibition-ameliorates-ischemic-acute-kidney-injury
#7
Julia Wilflingseder, Kíra Jelencsics, Helga Bergmeister, Judith Sunzenauer, Heinz Regele, Farsad Eskandary, Roman Reindl-Schwaighofer, Alexander Kainz, Rainer Oberbauer
Acute kidney injury (AKI) remains a major clinical event with high mortality rates. We previously identified renal miR-182 as the main driver of post-transplantation AKI. Therefore, we tested the causal inference of miR-182 by inhibiting its renal expression in vivo. In 45 rats AKI was induced by right nephrectomy and contralateral clamping of the renal pedicle for 40 minutes. Systemically administered antisense oligonucleotide (ASO) inhibited miR-182 in the kidneys up to 96 hours. The maximum creatinine elevation was on day 2 after injury (mg/dL; median and interquartile range): ASO 2...
January 2017: American Journal of Pathology
https://www.readbyqxmd.com/read/27861293/organ-pretreatment-with-cytotopic-endothelial-localizing-peptides-to-ameliorate-microvascular-thrombosis-and-perfusion-deficits-in-ex-vivo-renal-hemoreperfusion-models
#8
Karim Hamaoui, Sally Gowers, Martyn Boutelle, Terry H Cook, George Hanna, Ara Darzi, Richard Smith, Anthony Dorling, Vassilios Papalois
BACKGROUND: Hypothermic machine organ perfusion (HMP) offers opportunity to manipulate grafts with pharmacological agents prior to transplantation. Pretreating organs with novel cytotopic anticoagulant peptides that localize to endothelial cell membranes could ameliorate microvascular thrombotic sequelae posttransplantation. We describe experiments testing thrombalexin (TLN), a novel cell binding thrombin inhibitor, using porcine and unused human kidneys in a series of ex vivo normothermic hemoreperfusion models...
December 2016: Transplantation
https://www.readbyqxmd.com/read/27809409/the-24-hour-normothermic-machine-perfusion-of-discarded-human-liver-grafts
#9
Thomas Vogel, Jens G Brockmann, Alberto Quaglia, Alireza Morovat, Wayel Jassem, Nigel D Heaton, Constantin C Coussios, Peter J Friend
Donor organ shortage necessitates use of less than optimal donor allografts for transplantation. The current cold storage preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation (NMP) of liver allografts. In this study, we analyze discarded human liver grafts that underwent NMP for the extended period of 24 hours. Thirteen human liver grafts which had been discarded for transplantation were entered into this study...
February 2017: Liver Transplantation
https://www.readbyqxmd.com/read/27795989/normothermic-machine-perfusion-of-deceased-donor-liver-grafts-is-associated-with-improved-postreperfusion-hemodynamics
#10
Roberta Angelico, M Thamara P R Perera, Reena Ravikumar, David Holroyd, Constantin Coussios, Hynek Mergental, John R Isaac, Asim Iqbal, Hentie Cilliers, Paolo Muiesan, Peter J Friend, Darius F Mirza
BACKGROUND: Graft reperfusion poses a critical challenge during liver transplantation and can be associated with hemodynamic instability/postreperfusion syndrome. This is sequel to ischemia-reperfusion injury and normothermic machine preservation (NMP) may affect hemodynamic changes. Herein, we characterize postreperfusion hemodynamics in liver grafts after NMP and traditional cold preservation. MATERIALS AND METHODS: Intraoperative records of patients receiving grafts after NMP (n = 6; NMP group) and cold storage (CS) (n = 12; CS group) were compared...
September 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27783454/successful-donation-after-cardiac-death-liver-transplants-with-prolonged-warm-ischemia-time-using-normothermic-regional-perfusion
#11
Riccardo De Carlis, Stefano Di Sandro, Andrea Lauterio, Fabio Ferla, Antonio Dell'Acqua, Marinella Zanierato, Luciano De Carlis
The role of donation after cardiac death (DCD) in expanding the donor pool is mainly limited by the incidence of primary nonfunction (PNF) and ischemia-related complications. Even greater concern exists toward uncontrolled DCD, which represents the largest potential pool of DCD donors. We recently started the first Italian series of DCD liver transplantation, using normothermic regional perfusion (NRP) in 6 uncontrolled donors and in 1 controlled case to deal with the legally required no-touch period of 20 minutes...
February 2017: Liver Transplantation
https://www.readbyqxmd.com/read/27749583/maximizing-kidneys-for-transplantation-using-machine-perfusion-from-the-past-to-the-future-a-comprehensive-systematic-review-and-meta-analysis
#12
REVIEW
Ahmer M Hameed, Henry C Pleass, Germaine Wong, Wayne J Hawthorne
BACKGROUND: The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27718228/prediction-of-renal-function-upon-reperfusion-by-ex-situ-controlled-oxygenated-rewarming
#13
Thomas Minor, Katja Sutschet, Oliver Witzke, Andreas Paul, Anja Gallinat
BACKGROUND: Post-transplant function of suboptimal kidney grafts can be improved but not accurately predicted by hypothermic machine perfusion. Therefore, a new concept of ex situ pre-implantation machine perfusion with controlled rewarming up to subnormothermic temperatures was developed and evaluated. MATERIALS AND METHODS: Porcine kidneys (n = 6/group) were retrieved before or 30 min after cardiac arrest of the donor and subjected to 18 h of static cold storage...
December 2016: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/27639262/preliminary-single-center-canadian-experience-of-human-normothermic-ex-vivo-liver-perfusion-results-of-a-clinical-trial
#14
M Bral, B Gala-Lopez, D Bigam, N Kneteman, A Malcolm, S Livingstone, A Andres, J Emamaullee, L Russell, C Coussios, L J West, P J Friend, A M J Shapiro
After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver trial in the United Kingdom demonstrated feasibility and clear safety, with improved liver function compared with standard static cold storage (SCS). We present a preliminary single-center North American experience using identical NMP technology. Ten donor liver grafts were procured, four (40%) from donation after circulatory death (DCD), of which nine were transplanted. One liver did not proceed because of a technical failure with portal cannulation and was discarded...
September 17, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27495774/sequential-use-of-normothermic-regional-perfusion-and-hypothermic-machine-perfusion-in-donation-after-cardiac-death-liver-transplantation-with-extended-warm-ischemia-time
#15
Luciano De Carlis, Riccardo De Carlis, Andrea Lauterio, Stefano Di Sandro, Fabio Ferla, Marinella Zanierato
No abstract text is available yet for this article.
October 2016: Transplantation
https://www.readbyqxmd.com/read/27495754/organ-pretreatment-with-cytotopic-endothelial-localising-peptides-to-ameliorate-microvascular-thrombosis-perfusion-deficits-in-ex-vivo-renal-haemo-reperfusion-models
#16
Karim Hamaoui, Sally Gowers, Martyn Boutelle, Terry Cook, George Hanna, Ara Darzi, Richard Smith, Anthony Dorling, Vassilios Papalois
BACKGROUND: Hypothermic machine organ perfusion (HMP) offers opportunity to manipulate grafts with pharmacological agents prior to transplantation. Pretreating organs with novel cytotopic anti-coagulant peptides that localise to endothelial cell membranes could ameliorate microvascular thrombotic sequelae posttransplantation. We describe experiments testing Thrombalexin (TLN), a novel cell binding thrombin-inhibitor, using porcine and unused human kidneys in a series of ex-vivo normothermic haemo-reperfusion models...
August 5, 2016: Transplantation
https://www.readbyqxmd.com/read/27448845/liver-graft-preconditioning-preservation-and-reconditioning
#17
REVIEW
Nicholas Gilbo, Giorgia Catalano, Mauro Salizzoni, Renato Romagnoli
Liver transplantation is the successful treatment of end-stage liver disease; however, the ischaemia-reperfusion injury still jeopardizes early and long-term post-transplant outcomes. In fact, ischaemia-reperfusion is associated with increased morbidity and graft dysfunction, especially when suboptimal donors are utilized. Strategies to reduce the severity of ischaemia-reperfusion can be applied at different steps of the transplantation process: organ procurement, preservation phase or before revascularization...
November 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27398813/end-ischemic-reconditioning-of-liver-allografts-controlling-the-rewarming
#18
Dieter Paul Hoyer, Andreas Paul, Sebastian Luer, Henning Reis, Patrik Efferz, Thomas Minor
Different nonhypothermic preservation modalities have shown beneficial effects in liver transplantation models. This study compares controlled oxygenated rewarming (COR) to normothermic machine perfusion (NMP) to resuscitate liver grafts following cold storage (CS). Porcine livers were preserved for 18 hours by CS. Before reperfusion, the grafts were put on a machine perfusion device (Liver Assist) for 3 hours and were randomly assigned to COR (n = 6) or NMP (n = 5) and compared to standard CS. COR was carried out with the new Custodiol-N solution, slowly increasing temperature from 8 °C to 20 °C during the first 90 minutes...
September 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27273794/successful-transplantation-of-human-kidneys-deemed-untransplantable-but-resuscitated-by-ex-vivo-normothermic-machine-perfusion
#19
S A Hosgood, K Saeb-Parsy, M O Hamed, M L Nicholson
We report the successful transplantation of a pair of human kidneys that were declined for transplantation due to inadequate in situ perfusion but subsequently transplanted after perfusion and assessment using ex vivo normothermic perfusion (EVNP). The kidneys were from a 35-year-old man, a donation after circulatory death donor. Both kidneys were declined by all UK transplant centers. On arrival, the kidneys had significant areas of incomplete clearance of blood from the microcirculation that did not clear after a further attempt to flush them...
November 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27192971/transplantation-of-declined-liver-allografts-following-normothermic-ex-situ-evaluation
#20
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
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