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normothermic machine perfusion

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)
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. METHODS: Porcine kidneys (n= 6/ group) were retrieved before or 30 min after cardiac arrest of the donor and subjected to 18 hours of static cold storage. In some cases 90 min of machine controlled oxygenated rewarming (COR) was added thereafter...
October 8, 2016: European Journal of Clinical Investigation
Mariusz Bral, Boris Gala-Lopez, David Bigam, Norman Kneteman, Andrew Malcolm, Scott Livingstone, Axel Andres, Juliet Emamaullee, Leslie Russell, Constantin Coussios, Lori J West, Peter J Friend, A M James Shapiro
After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver UK trial demonstrated feasibility and clear safety, with improved liver function when compared to standard static cold storage (SCS). We herein present a preliminary single centre North-American experience using identical NMP technology. Ten donor liver grafts were procured, 4 (40%) from donation after circulatory death (DCD) donors of which 9 were transplanted. One liver did not proceed due to a technical failure with portal cannulation, and discarded...
September 17, 2016: American Journal of Transplantation
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
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
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...
July 9, 2016: Digestive and Liver Disease
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
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 35y male, donation after circulatory death (DCD) donor. Both kidneys were declined by all UK transplant centres. On arrival, the kidneys had significant areas of incomplete clearance of blood from the microcirculation which didn't clear after a further attempt to flush them...
June 7, 2016: American Journal of Transplantation
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
Michael A Zimmerman, Alicia Martin, Johnny C Hong
PURPOSE OF REVIEW: Owing to a severe shortage of organs for patients with end-stage diseases, novel techniques in organ preservation and perfusion need to be studied and reviewed to increase the number of available organs for transplant. Many patients will die while waiting for an organ. To make organs from extended-criteria donors feasible, optimal conditions for pulsatile perfusion and the potential for organ reconditioning at implantation need to be addressed. RECENT FINDINGS: Many techniques in organ preservation and perfusion are being studied...
June 2016: Current Opinion in Organ Transplantation
Ahmed Nassar, Qiang Liu, Kevin Farias, Laura Buccini, William Baldwin, Ana Bennett, Martin Mangino, Samuel Irefin, Jacek Cywinski, Toshihiro Okamoto, Teresa Diago Uso, Giuseppe Iuppa, Basem Soliman, Charles Miller, Cristiano Quintini
Normothermic machine perfusion (NMP) has been introduced as a promising technology to preserve and possibly repair marginal liver grafts. The aim of this study was to compare the effect of temperature on the preservation of donation after cardiac death (DCD) liver grafts in an ex vivo perfusion model after NMP (38.5°C) and subnormothermic machine perfusion (SNMP, 21°C) with a control group preserved by cold storage (CS, 4°C). Fifteen porcine livers with 60 min of warm ischemia were preserved for 10 h by NMP, SNMP or CS (n = 5/group)...
April 18, 2016: Artificial Organs
Panagiotis G Athanasopoulos, Christopher Hadjittofi, Arinda Dinesh Dharmapala, Rafael Jose Orti-Rodriguez, Alessandra Ferro, David Nasralla, Sofia K Konstantinidou, Massimo Malagó
Donor organ shortage continues to limit the availability of liver transplantation, a successful and established therapy of end-stage liver diseases. Strategies to mitigate graft shortage include the utilization of marginal livers and recently ex-situ normothermic machine perfusion devices. A 59-year-old woman with cirrhosis due to primary sclerosing cholangitis was offered an ex-situ machine perfused graft with unnoticed severe injury of the suprahepatic vasculature due to road traffic accident. Following a complex avulsion, repair and reconstruction of all donor hepatic veins as well as the suprahepatic inferior vena cava, the patient underwent a face-to-face piggy-back orthotopic liver transplantation and was discharged on the 11th postoperative day after an uncomplicated recovery...
April 2016: Medicine (Baltimore)
Zhi-Bin Zhang, Wei Gao, Yuan Shi, Lei Liu, Ning Ma, Jing Chen, Zhi-Jun Zhu
The purpose of this study is to explore whether normothermic machine perfusion (NMP) preservation is superior to cold preservation during reduced-size liver transplantation (RSLT) in pigs. Twenty-four healthy Ba-Ma mini pigs were used (aged >13 months; weight 25-35 kg; regardless of sex). The animals were randomized into 2 groups. In group A (NMP), donor livers were harvested without warm ischemia time and heartbeats and then were connected to the NMP system to reduce the livers' size under the normothermic condition...
July 2016: Liver Transplantation
Andrew Ian Sutherland, Gabriel C Oniscu
In recent years, there has been a shift in the donor demographics with an increase in donation after circulatory death (DCD). Livers obtained from DCD donors are known to have poorer outcomes when compared to donors after brainstem death and currently only a small proportion of DCD livers are used. This review outlines the recent technological developments in liver DCD donation, including clinical studies using normothermic regional perfusion and extracorporal machine perfusion of livers from DCD donors.
January 2016: Journal of Natural Science, Biology, and Medicine
Peter S Macdonald, Hong C Chew, Mark Connellan, Kumud Dhital
PURPOSE OF REVIEW: Cold static storage is a time-tested and simple method of preserving hearts retrieved from optimal donors after brain death (DBD). The increasing gap between supply and demand for donor organs together with changing donor and recipient characteristics have led to renewed interest in the use of machine perfusion to increase both the quality and quantity of donor hearts for transplantation. RECENT FINDINGS: Two major approaches to machine perfusion of donor hearts have been investigated - hypothermic (HMP) and normothermic machine perfusion (NMP)...
June 2016: Current Opinion in Organ Transplantation
Sanna Op den Dries, Negin Karimian, Andrie C Westerkamp, Michael E Sutton, Michiel Kuipers, Janneke Wiersema-Buist, Petra J Ottens, Jeroen Kuipers, Ben N Giepmans, Henri G D Leuvenink, Ton Lisman, Robert J Porte
Bile duct injury may occur during liver procurement and transplantation, especially in livers from donation after circulatory death (DCD) donors. Normothermic machine perfusion (NMP) has been shown to reduce hepatic injury compared to static cold storage (SCS). However, it is unknown whether NMP provides better preservation of bile ducts. The aim of this study was to determine the impact of NMP on bile duct preservation in both DCD and non-DCD livers. DCD and non-DCD livers obtained from Lewis rats were preserved for 3 hours using either SCS or NMP, followed by 2 hours ex vivo reperfusion...
July 2016: Liver 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
Andrie C Westerkamp, Negin Karimian, Alix P M Matton, Paria Mahboub, Rianne van Rijn, Janneke Wiersema-Buist, Marieke T de Boer, Henri G D Leuvenink, Annette S H Gouw, Ton Lisman, Robert J Porte
BACKGROUND: The mechanism through which oxygenated hypothermic machine perfusion (HMP) improves viability of human extended criteria donor (ECD) livers is not well known. Aim of this study was to examine the benefits of oxygenated HMP after static cold storage (SCS). METHODS: Eighteen ECD livers that were declined for transplantation underwent ex situ viability testing using normothermic (37 °C) machine perfusion (NMP) after traditional SCS (0 °C-4 °C) for 7 to 9 hours...
April 2016: Transplantation
Radhika Chadha, Mohammad Ayaz Hossain, Atul Bagul
No abstract text is available yet for this article.
2016: Expert Review of Medical Devices
Q Liu, A Nassar, K Farias, L Buccini, M J Mangino, W Baldwin, A Bennett, C O'Rourke, G Iuppa, B G Soliman, D Urcuyo-Llanes, T Okamoto, T D Uso, J Fung, K Abu-Elmagd, C Miller, C Quintini
The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc...
March 2016: American Journal of Transplantation
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