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Normothermic perfusion

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https://www.readbyqxmd.com/read/28327077/regional-muscle-tissue-saturation-is-an-indicator-of-global-inadequate-circulation-during-cardiopulmonary-bypass-a-randomized-porcine-study-using-muscle-intestinal-and-brain-tissue-metabolomics
#1
Sisse Anette Thomassen, Benedict Kjærgaard, Preben Sørensen, Jan Jesper Andreasen, Anders Larsson, Bodil Steen Rasmussen
BACKGROUND: Muscle tissue saturation (StO2) measured with near-infrared spectroscopy has generally been considered a measurement of the tissue microcirculatory condition. However, we hypothesized that StO2 could be more regarded as a fast and reliable measure of global than of regional circulatory adequacy and tested this with muscle, intestinal and brain metabolomics at normal and two levels of low cardiopulmonary bypass blood flow rates in a porcine model. METHODS: Twelve 80 kg pigs were connected to normothermic cardiopulmonary bypass with a blood flow of 60 mL/kg/min for one hour, reduced randomly to 47...
April 2017: Perfusion
https://www.readbyqxmd.com/read/28322021/cytoprotective-and-antioxidant-effects-of-steen-solution-on-human-lung-spheroids-and-human-endothelial-cells
#2
Francesca Pagano, Cristina Nocella, Sebastiano Sciarretta, Luca Fianchini, Camilla Siciliano, Giorgio Mangino, Mohsen Ibrahim, Elena De Falco, Roberto Carnevale, Isotta Chimenti, Giacomo Frati
Respiratory diseases represent a major healthcare burden worldwide. Lung transplantation (LTx) is the gold-standard for end-stage patients, strongly limited by shortage of available/suitable donor lungs. Normothermic ex vivo lung perfusion (EVLP) has significantly increased the number of lungs suitable for transplantation. Steen solution is used for EVLP, but the mechanisms involved in its beneficial properties remain to be clarified. We investigated the effects of Steen solution in an in vitro protocol of cold starvation and normothermic recovery (CS/NR) on human lung spheroids, named pneumospheres (PSs), containing epithelial/basal cells, and on endothelial HUVEC cells...
March 20, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28314503/standard-donor-lung-procurement-with-normothermic-ex-vivo-lung-perfusion-a-prospective-randomized-clinical-trial
#3
Alexis Slama, Lukas Schillab, Maximilian Barta, Aris Benedek, Andreas Mitterbauer, Konrad Hoetzenecker, Shahrokh Taghavi, Gyoergy Lang, Jose Matilla, Hendrik Ankersmit, Helmut Hager, Georg Roth, Walter Klepetko, Clemens Aigner
BACKGROUND: Ex vivo lung perfusion (EVLP) was primarily developed for evaluation of impaired donor lungs. The good clinical results raise the question for its possible impact on lungs meeting standard criteria. Before application of EVLP on such lungs enters routine clinical practice, it must be demonstrated whether EVLP would affect or improve outcome when used in standard donor lungs. We performed a prospective randomized trial to investigate the role of EVLP in standard lung transplantation (Tx)...
February 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#4
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28306594/extending-normothermic-regional-perfusion-to-the-thorax-in-donors-after-circulatory-death
#5
Steven S L Tsui, Gabriel C Oniscu
PURPOSE OF REVIEW: Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. RECENT FINDINGS: The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded...
March 16, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301388/cold-storage-or-normothermic-perfusion-for-liver-transplantation-probable-application-and-indications
#6
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
#7
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/28275061/impaired-sweating-responses-to-a-passive-whole-body-heat-stress-in-individuals-with-multiple-sclerosis
#8
Dustin R Allen, Mu Huang, Iqra M Parupia, Ariana R Dubelko, Elliot M Frohman, Scott L Davis
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), disrupting autonomic function. The aim of this study was to test the hypothesis that individuals with MS have blunted control of thermoregulatory reflex increases in sweat rate (SR) and cutaneous vasodilation compared to controls during a passive whole-body heat stress (WBH). Eighteen individuals with relapsing-remitting MS and 18 healthy controls (CON) participated in the study. Core temperature (Tcore), skin temperature, heart rate, arterial blood pressure (10 min intervals), skin blood flow (laser-Doppler flux: LDF), and SR were continuously measured during normothermic baseline (34 °C water perfusing a tube-lined suit) and WBH (increased Tcore 0...
March 8, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28254750/the-roles-of-kca-katp-and-kv-channels-in-regulating-cutaneous-vasodilation-and-sweating-during-exercise-in-the-heat
#9
Jeffrey C Louie, Naoto Fujii, Robert D Meade, Brendan D McNeely, Glen P Kenny
We recently showed the varying roles of Ca(2+)-activated (KCa), ATP-sensitive (KATP) and voltage-gated (KV) K(+) channels in regulating cholinergic cutaneous vasodilation and sweating in normothermic conditions. However, it is unclear whether the respective contributions of these K(+) channels remain intact during dynamic exercise in the heat. Eleven young (23±4 years) males completed a 30-min exercise bout at a fixed rate of metabolic heat production (400 W), followed by a 40-min recovery period in the heat (35°C, 20% relative humidity)...
March 2, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
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
#10
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/28222055/ex-situ-perfusion-of-human-limb-allografts-for-24-hours
#11
Nicole L Werner, Fares Alghanem, Stephanie L Rakestraw, Dylan C Sarver, Bruce Nicely, Richard E Pietroski, Paul Lange, Steven M Rudich, Christopher L Mendias, Alvaro Rojas-Pena, John C Magee, Robert H Bartlett, Kagan Ozer
BACKGROUND: Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion. METHODS: Upper limbs were procured from brain-dead organ donors...
March 2017: Transplantation
https://www.readbyqxmd.com/read/28188500/isolated-limb-perfusion-for-melanoma-is-safe-and-effective-in-elderly-patients
#12
Max F Madu, Marion M Deken, Jos A van der Hage, Katarzyna Jóźwiak, Michel W J M Wouters, Alexander C J van Akkooi
BACKGROUND: Data on isolated limb perfusion (ILP) in elderly melanoma patients are scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients. METHODS: We performed retrospective analysis of stage IIIB/C melanoma patients who underwent ILP for melanoma in-transit metastases (ITMs) in our institution between 2000 and 2016. Normothermic ILP was performed with either melphalan or melphalan and tumor necrosis factor...
February 10, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28141909/improving-the-outcomes-of-organs-obtained-from-controlled-donation-after-circulatory-death-donors-using-abdominal-normothermic-regional-perfusion
#13
Eduardo Miñambres, Borja Suberviola, Beatriz Dominguez-Gil, Emilio Rodrigo, Juan Carlos Ruiz-San Millan, Juan Carlos Rodríguez-San Juan, Maria Angeles Ballesteros
Donation after circulatory death (DCD) has experienced a significant expansion over the last decade. However, warm ischemia results in a greater risk for transplantation. Indeed, controlled DCD (cDCD) was associated with inferior outcomes compared to donation after brain death. The use of abdominal normothermic regional perfusion (nRP) to restore blood flow prior to organ recovery in cDCD has been proposed as a better alternative than rapid recovery to reverse the effect of ischemia and improve recipients' outcome...
January 31, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28121911/normothermic-perfusion-in-the-assessment-and-preservation-of-declined-livers-prior-to-transplantation-hyperoxia-and-vasoplegia-important-lessons-from-the-first-12-cases
#14
Christopher J E Watson, Vasilis Kosmoliaptsis, Lucy V Randle, Alexander E Gimson, Rebecca Brais, John R Klinck, Mazin Hamed, Anastasia Tsyben, Andrew J Butler
BACKGROUND: A programme of normothermic ex situ liver perfusion (NESLiP) was developed to facilitate better assessment and use of marginal livers, while minimising cold ischaemia. METHODS: Declined marginal livers and those offered for research were evaluated. NESLiP was performed using an erythrocyte-based perfusate. Viability was assessed with reference to biochemical changes in the perfusate. RESULTS: 12 livers (9 from circulatory death (DCD) and 3 from brain-dead donors), median Donor Risk Index 2...
January 25, 2017: Transplantation
https://www.readbyqxmd.com/read/28115329/protocol-of-a-randomised-controlled-open-label-trial-of-ex-vivo-normothermic-perfusion-versus-static-cold-storage-in-donation-after-circulatory-death-renal-transplantation
#15
Sarah A Hosgood, Kourosh Saeb-Parsy, Colin Wilson, Christopher Callaghan, Dave Collett, Michael L Nicholson
INTRODUCTION: Ex vivo normothermic perfusion (EVNP) is a novel technique that reconditions the kidney and restores renal function prior to transplantation. Phase I data from a series of EVNP in extended criteria donor kidneys have established the safety and feasibility of the technique in clinical practice. METHODS AND ANALYSIS: This is a UK-based phase II multicentre randomised controlled trial to assess the efficacy of EVNP compared with the conventional static cold storage technique in donation after circulatory death (DCD) kidney transplantation...
January 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28052693/safety-and-efficacy-of-ex-vivo-donor-lung-adenoviral-il-10-gene-therapy-in-a-large-animal-lung-transplant-survival-model
#16
Tiago N Machuca, Marcelo Cypel, Riccardo Bonato, Jonathan C Yeung, Yi-Min Chun, Stephen Juvet, Zehong Guan, David M Hwang, Manyin Chen, Tomohito Saito, Constantine Harmantas, Beverly L Davidson, Thomas K Waddell, Mingyao Liu, Shaf Keshavjee
Ex vivo normothermic lung perfusion (EVLP) is a novel platform and method developed to facilitate functional assessment and implementation of advanced therapies for donor lungs prior to transplantation. This study aimed to determine the safety and immunological and functional benefits of ex vivo adenoviral human interleukin-10 (AdhIL-10) gene delivery to prevent the development of primary graft dysfunction in a large animal survival model. Pig donor lungs were retrieved, preserved for 6 h at 4°C, and then randomly assigned to four groups: (1) AdhIL-10 gene therapy: 12 h EVLP + AdhIL-10 intra-bronchial delivery; (2) EVLP-control: 12 h EVLP; (3) Vector-control: 12 h EVLP + adenoviral vector intra-bronchial delivery; and (4) prolonged hypothermic preservation: additional 12 h of cold ischemia...
January 4, 2017: Human Gene Therapy
https://www.readbyqxmd.com/read/28040765/classification-and-outcomes-of-extended-arch-repair-for-acute-type-a-aortic-dissection-a-systematic-review-and-meta-analysis
#17
REVIEW
Holly N Smith, Munir Boodhwani, Maral Ouzounian, Richard Saczkowski, Alexander J Gregory, Eric J Herget, Jehangir J Appoo
OBJECTIVES: Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28009782/prolonged-evlp-using-ocs-lung-cellular-and-acellular-perfusates
#18
Gabriel Loor, Brian T Howard, John R Spratt, Lars M Mattison, Angela Panoskaltsis-Mortari, Roland Z Brown, Tinen L Iles, Carolyn M Meyer, Haylie Helms, Andrew Price, Paul A Iaizzo
BACKGROUND: We report the ability to extend lung preservation up to 24 hours (24H) by using autologous whole donor blood circulating within an ex vivo lung perfusion (EVLP) system. This approach facilitates donor lung reconditioning in a model of extended normothermic EVLP. We analyzed comparative responses to cellular and acellular perfusates to identify these benefits. METHODS: Twelve pairs of swine lungs were retrieved after cardiac arrest and studied for 24H on the Organ Care System (OCS) Lung EVLP platform...
December 22, 2016: Transplantation
https://www.readbyqxmd.com/read/28006866/liver-splitting-during-normothermic-organ-preservation
#19
Jens G Brockmann, Thomas Vogel, Constantin Coussios, Peter J Friend
Classical split liver transplantation has proved a successful means of transplanting children with size-matched organs without reducing the adult cadaveric liver pool. However, the conventional technique of liver splitting after retrieval (ex situ) implies either increasing the ischaemia time of one graft or the logistic problems of simultaneous transplants in a single institution. Splitting the liver in the donor (in situ splitting) minimises cold ischaemia but greatly increases the operating time in the donor hospital and requires highly specialised hepatobiliary expertise at time of organ donation...
December 22, 2016: 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
#20
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
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