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Normothermic perfusion

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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/29757899/determination-of-minimal-hemoglobin-level-necessary-for-normothermic-porcine-ex-situ-liver-perfusion
#3
Mariusz Bral, Boris Gala-Lopez, Aducio Thiesen, Sanaz Hatami, David L Bigam, Darren M Freed, A M James Shapiro
BACKGROUND: In current studies of ex situ liver perfusion there exists considerable variability in perfusate composition, including the type of oxygen carrier. Herein we aim to clarify the minimal hemoglobin level necessary during normothermic porcine ex situ liver perfusion. METHODS: Livers procured from 35- 45 Kg domestic pigs were connected to our experimental ex situ circuit (n=10). In the treatment group, perfusate was sequentially diluted hourly to predetermined hemoglobin levels...
May 7, 2018: Transplantation
https://www.readbyqxmd.com/read/29752920/direct-heart-procurement-following-donation-after-circulatory-death-with-ex-situ-reperfusion
#4
Hassiba Smail, Diana Garcia Saez, Ulrich Stock, Hesham Ahmed Hassan, Christopher Bowles, Barlomiej Zych, Prashant N Mohite, Olaf Maunz, Andre R Simon
The most extended technique of Heart procurement from donors after circulatory death (DCD)involves direct procurement and reperfusion in ex situ normothermic platform using Organ Care System (OCS). We describe a modified technique at our institution with rapid donor blood drainage using a cell saver and synchronised perfusion on the OCS.
May 9, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29731238/human-heart-transplantation-from-donation-after-circulatory-determined-death-donors-using-normothermic-regional-perfusion-and-cold-storage
#5
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/29730345/hemiarch-reconstruction-vs-clamped-aortic-anastomosis-for-concomitant-ascending-aortic-aneurysm
#6
Ibrahim Sultan, Valentino Bianco, Ibrahim Yajzi, Arman Kilic, Keith Dufendach, Arturo Cardounel, Andrew D Althouse, Ahmad Masri, Forozan Navid, Thomas G Gleason
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating other cardiac disease to avoid increased risk of morbidity and mortality. We hypothesized that the use of DHCA with retrograde cerebral perfusion (RCP) does not add incremental risk to ascending aortic replacement alone in the setting of concomitant cardiac surgery. METHODS: 408 ascending aortic ± hemiarch replacements and aortic (root)/mitral/tricuspid valve(s), CABG, or MAZE procedures were performed for concomitant cardiac disease...
May 3, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29730077/ex-vivo-normothermic-porcine-pancreas-a-physiological-model-for-preservation-and-transplant-study
#7
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/29697462/ex-vivo-machine-perfusion-for-kidney-preservation
#8
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/29683999/normothermic-ex-vivo-kidney-perfusion-reduces-warm-ischemic-injury-of-porcine-kidney-grafts-retrieved-after-circulatory-death-dcd
#9
Matyas Hamar, Peter Urbanellis, Moritz Johann Kaths, Dagmar Kollmann, Ivan Linares, Sujani Ganesh, Aryn Wiebe, Jun Yu Cen, Paul M Yip, Rohan John, Ana Konvalinka, Istvan Mucsi, Anand Ghanekar, Darius Bagli, David R Grant, Lisa A Robinson, Markus Selzner
BACKGROUND: Cold storage is poorly tolerated by kidney grafts retrieved after Donation after Circulatory Death (DCD). It has been determined that normothermic ex vivo kidney perfusion (NEVKP) preservation decreases injury by minimizing cold ischemic storage. The impact of NEVKP on warm ischemic injury is unknown. METHODS: We compared pig kidneys retrieved after 30minutes warm ischemia and immediate transplantation (no-preservation) with grafts that were exposed to 30min of warm ischemia plus 8hr NEVKP or plus 8hr SCS...
April 21, 2018: Transplantation
https://www.readbyqxmd.com/read/29677080/corm-401-reduces-ischemia-reperfusion-injury-in-an-ex-vivo-renal-porcine-model-of-the-donation-after-cardiac-death
#10
Rabindra N Bhattacharjee, Mahms Richard-Mohamed, Qizhi Sun, Aaron Haig, Ghaleb Aboalsamh, Peter Barrett, Richard Mayer, Ibrahim Alhasan, Karen Pineda-Solis, Larry Jiang, Hajed Alharbi, Manujendra Saha, Eric Patterson, Alp Sener, Gediminas Cepinskas, Anthony M Jevnikar, Patrick P W Luke
BACKGROUND: Carbon monoxide (CO) inhalation protects organ by reducing inflammation and cell death during transplantation processes in animal model. However, using CO in clinical transplantation is difficult due to its delivery in a controlled manner. A manganese-containing CORM-401 has recently been synthesized which can efficiently deliver 3 molar equivalents of CO. We report the ability of this anti-inflammatory CORM-401 to reduce ischemia reperfusion injury associated with prolonged cold storage of renal allografts obtained from donation after cardiac death in a porcine model of transplantation...
April 19, 2018: Transplantation
https://www.readbyqxmd.com/read/29674604/does-ischemia-free-liver-procurement-under-normothermic-perfusion-benefit-the-outcome-of-liver-transplantation
#11
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
#12
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
#13
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
#14
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/29619907/severe-atherosclerosis-in-donor-liver-vasculature-an-illustrative-case-report-and-review-of-the-literatur
#15
Ayokunle S Olowofela, Oscar K Serrano, Raja Kandaswamy
As the scarcity of transplantable organs continues to increase, juxtaposed with an aging donor population, transplant surgeons are increasingly confronted with marginal organ offers. The presence of atherosclerosis in the donor allograft has been shown to compromise the vascular integrity and predispose to vascular complications in the transplanted liver. Here, we present a case of 54-year-old brain-dead donor who was discovered to have a severely diseased aorta during organ recovery. Pathologic evaluation revealed severe atherosclerosis with calcifications...
April 4, 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29609847/angiotensin-iv-improves-subnormothermic-machine-perfusion-preservation-of-rat-liver-graft
#16
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/29595532/development-of-an-ex-situ-limb-perfusion-system-for-a-rodent-model
#17
Emre Gok, Fares Alghanem, Ruth Moon, Erin Guy, Alvaro Rojas-Pena, Robert H Bartlett, Kagan Ozer
Ex-situ perfusion (ESP) is a promising method in preserving vascularized composite tissue allografts (VCAs) with potential to widen donor procurement to larger geographic areas. To optimize the method of preservation, we developed a small animal model to conduct biomolecular investigations. Twenty rat hind limbs (18.2 ± 1.3 g) were procured and connected to our custom-made ESP system. Perfusion pressure and flow parameters were measured with hourly blood gas analysis under near-normothermic (30-35˚C) conditions...
March 26, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29572320/decreased-camp-level-and-decreased-downregulation-of-%C3%AE-1-adrenoceptor-expression-in-therapeutic-hypothermia-resuscitated-myocardium-are-associated-with-improved-post-resuscitation-myocardial-function
#18
Wei Wang, Tianfeng Hua, Hao Li, Xiaobo Wu, Jennifer Bradley, Mary Ann Peberdy, Joseph P Ornato, Wanchun Tang
BACKGROUND: Epinephrine administered during cardiopulmonary resuscitation (CPR) is associated with severe post-resuscitation myocardial dysfunction. We previously demonstrated that therapeutic hypothermia reduced the severity of post-resuscitation myocardial dysfunction caused by epinephrine; however, the relationship between myocardial adrenoceptor expression and myocardial protective effects by hypothermia remains unclear. METHODS AND RESULTS: Rats weighing between 450 and 550 g were randomized into 5 groups: (1) normothermic placebo, (2) normothermic epinephrine, (3) hypothermic placebo, (4) hypothermic epinephrine, and (5) sham (not subject to cardiac arrest and resuscitation)...
March 23, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29567935/normothermic-machine-perfusion-versus-cold-storage-of-liver-in-pig-model-a-meta-analysis
#19
Shiqi Bian, Zhijun Zhu, Liying Sun, Lin Wei, Wei Qu, Zhigui Zeng, Ying Liu
BACKGROUND Normothermic machine perfusion (NMP) is a novel strategy used for organ preservation. We aimed to determine the overall efficacy of NMP for liver preservation versus traditional static cold storage (CS). MATERIAL AND METHODS We performed a meta-analysis of the literature to evaluate the efficacy of NMP in experimental pig models of liver preservation. We use the standardized mean difference and 95% confidence intervals (CI) to calculate statistics and used the random effects model for the combined analysis of the results...
March 23, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29564207/normothermic-machine-preservation-of-the-liver-state-of-the-art
#20
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
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