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Normothermic perfusion

Christopher W White, Simon J Messer, Stephen R Large, Jennifer Conway, Daniel H Kim, Demetrios J Kutsogiannis, Jayan Nagendran, Darren H Freed
Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD) have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement...
2018: Frontiers in Cardiovascular Medicine
M Barber Ansón, A N García Herrera, J Roldán Ramírez, M Loinaz Bordonabe, O Agudo Pascual, I Osés Munarriz
Donation after circulatory death (Maastricht type III donation) or controlled cardiac death refers to the retrieval of organs for transplantation purposes following death confirmed using circulatory criteria after the withdrawal of life support. The persistent shortfall in organ availability has prompted the development of donation programs following circulatory death for lung transplantation. The combined thorax-abdomen extraction in these cases is carried out in only twelve centres in Spain, while the combined use of abdominal normothermic regional perfusion (NRP) is even more exceptional...
February 21, 2018: Anales del Sistema Sanitario de Navarra
Irina Studneva, Valentin Shulzhenko, Oksana Veselova, Oleg Pisarenko
The maintenance of nitric oxide (NO) bioavailability has been recognized as an important component of myocardial protection during cardiac surgery. This study was designed to evaluate the efficacy of using two NO-donating compounds in cardioplegia and reperfusion: (i) a modified peptide apelin-12 (MA12) that activates endothelial NO synthase (eNOS) and (ii) dinitrosyl iron complexes with reduced glutathione (DNIC-GS), a natural NO vehicle. Isolated perfused working rat hearts were subjected to normothermic global ischemia and reperfusion...
February 20, 2018: Journal of Physiology and Biochemistry
Jonathan C Yeung, Ricardo Zamel, William Klement, Xiao-Hui Bai, Tiago N Machuca, Thomas K Waddell, Mingyao Liu, Marcelo Cypel, Shaf Keshavjee
We and others have demonstrated that acellular normothermic ex vivo lung perfusion of high-risk donor lungs can result in post-transplant outcomes equivalent to that of contemporaneous lung transplantation using standard donor lungs. However, the mechanism of this effect remains unclear. Given the restoration of cellular metabolic activity during normothermic perfusion, one possibility is that of lung healing via natural innate recovery mechanisms. We explored this by examining the gene expression changes occurring in human lungs during ex vivo lung perfusion...
February 15, 2018: American Journal of Transplantation
Federica Rigo, Nicola De Stefano, Victor Navarro-Tableros, Ezio David, Giorgia Rizza, Giorgia Catalano, Nicholas Gilbo, Francesca Maione, Federica Gonella, Dorotea Roggio, Silvia Martini, Damiano Patrono, Mauro Salizzoni, Giovanni Camussi, Renato Romagnoli
BACKGROUND: The gold standard for organ preservation before transplantation is static cold storage, which is unable to fully protect suboptimal livers from ischemia/reperfusion injury. An emerging alternative is normothermic machine perfusion (NMP), which permits organ reconditioning. Here, we aimed to explore the feasibility of a pharmacological intervention on isolated rat livers by using a combination of NMP and human liver stem cells-derived extracellular vesicles (HLSC-EV). METHODS: We established an ex vivo murine model of NMP capable to maintain liver function despite an ongoing hypoxic injury induced by hemodilution...
February 9, 2018: Transplantation
Christopher J E Watson, Vasilis Kosmoliaptsis, Caitlin Pley, Lucy Randle, Corinna Fear, Keziah Crick, Alexander E Gimson, Michael Allison, Sara Upponi, Rebecca Brais, Ina Jochmans, Andrew J Butler
Normothermic ex situ liver perfusion might allow viability assessment of livers before transplantation. Perfusion characteristics were studied in 47 liver perfusions, of which 22 resulted in transplants. Hepatocellular damage was reflected in the perfusate transaminase concentrations, which correlated with post-transplant peak transaminase levels. Lactate clearance occurred within 3 hours in 46 of 47 perfusions, and glucose rose initially during perfusion in 44. Three livers required higher levels of bicarbonate support to maintain physiological pH, including one developing primary non-function...
February 8, 2018: American Journal of Transplantation
Ashish K Sharma, Victor E Laubach
No abstract text is available yet for this article.
February 5, 2018: Transplantation
Akiko Kojima, Yutaka Fukushima, Yuki Ito, Wei-Guang Ding, Hirotoshi Kitagawa, Hiroshi Matsuura
Reperfusion of ischemic myocardium is accompanied by intracellular Ca overload, leading to cardiac dysfunction. However, the mechanisms underlying intracellular Ca overload have yet to be fully elucidated. The mechanism may involve the activation of store-operated Ca entry, which is primarily mediated through the transient receptor potential canonical (TRPC) channels. The present study was undertaken to examine the possible involvement of TRPC channels in the development of contractile dysfunction associated with reperfusion of ischemic myocardium using a mouse heart model...
January 30, 2018: Journal of Cardiovascular Pharmacology
Jaskiran K Sandha, Christopher W White, Alison Müller, Emma Avery, James Thliveris, Ian M C Dixon, Rakesh C Arora, Ganghong Tian, Larry V Hryshko, Jayan Nagendran, Darren H Freed
BACKGROUND: Normothermic ex vivo heart perfusion (EVHP) has been shown to improve the preservation of hearts donated after circulatory arrest and facilitate clinical successful transplantation. Steroids are added to the perfusate solution in current clinical EVHP protocols; however, the impact of this approach on donor heart preservation has not been previously investigated. We sought to determine the impact of steroids on the inflammatory response and development of myocardial edema during EVHP...
January 27, 2018: Annals of Thoracic Surgery
Sisse Anette Thomassen, Benedict Kjærgaard, Aage Kristian Olsen Alstrup, Ole Lajord Munk, Jørgen Frøkiær, Anders Larsson, Bodil Steen Rasmussen
BACKGROUND: Mean arterial blood pressure (MAP) and/or pump flow during normothermic cardiopulmonary bypass (CPB) are the most important factors of cerebral perfusion. The aim of this study was to explore the influence of CPB blood flow on cerebral blood flow (CBF) measured by dynamic positron emission tomography (PET) using 15O-labelled water with no pharmacological interventions to maintain the MAP. METHODS: Eight pigs (69-71 kg) were connected to normothermic CPB...
January 1, 2018: Perfusion
Yuri L Boteon, Richard Laing, Hynek Mergental, Gary M Reynolds, Darius F Mirza, Simon C Afford, Ricky H Bhogal
Ischaemia-reperfusion injury (IRI) is the leading cause of injury seen in the liver following transplantation. IRI also causes injury following liver surgery and haemodynamic shock. The first cells within the liver to be injured by IRI are the liver sinusoidal endothelial cells (LSEC). Recent evidence suggests that LSEC co-ordinate and regulates the livers response to a variety of injuries. It is becoming increasingly apparent that the cyto-protective cellular process of autophagy is a key regulator of IRI...
December 28, 2017: World Journal of Gastroenterology: WJG
Constantine D Mavroudis, Michael Karlsson, Tiffany Ko, Marco Hefti, Javier I Gentile, Ryan W Morgan, Ross Plyler, Kobina G Mensah-Brown, Timothy W Boorady, Richard W Melchior, Tami M Rosenthal, Brandon C Shade, Kellie L Schiavo, Susan C Nicolson, Thomas L Spray, Robert M Sutton, Robert A Berg, Daniel J Licht, J William Gaynor, Todd J Kilbaugh
OBJECTIVES: Controversy remains regarding the use of deep hypothermic circulatory arrest (DHCA) in neonatal cardiac surgery. Alterations in cerebral mitochondrial bioenergetics are thought to contribute to ischaemia-reperfusion injury in DHCA. The purpose of this study was to compare cerebral mitochondrial bioenergetics for DHCA with deep hypothermic continuous perfusion using a neonatal swine model. METHODS: Twenty-four piglets (mean weight 3.8 kg) were placed on cardiopulmonary bypass (CPB): 10 underwent 40-min DHCA, following cooling to 18°C, 10 underwent 40 min DHCA and 10 remained at deep hypothermia for 40 min; animals were subsequently rewarmed to normothermia...
January 15, 2018: European Journal of Cardio-thoracic Surgery
Ahmed Nassar, Cristiano Quintini
No abstract text is available yet for this article.
January 11, 2018: Transplantation
Karim Hamaoui, Sally Gowers, Bynvant Sandhu, Natalie Vallant, Terry Cook, Martyn Boutelle, Daniel Casanova, Vassilios Papalois
BACKGROUND: Hypothermic machine perfusion (HMP) is increasingly being used for extended criteria kidney grafts. Pancreatic HMP is challenging because physiologically the pancreas is a low-flow organ susceptible to edema. We report the successful development of preclinical HMP models using porcine pancreases, as well as human pancreases unsuitable for clinical transplantation. METHODS: Ten porcine pancreases were used in the development of these perfusion models...
January 8, 2018: Journal of Surgical Research
Zhi-Bin Zhang, Lei Liu, Wei Gao, Yuan Shi, Ning Ma, Zhong-Yang Shen
No abstract text is available yet for this article.
January 5, 2018: Liver Transplantation
Claire Delsuc, Alexandre Faure, Julien Berthiller, Didier Dorez, Xavier Matillon, Vannary Meas-Yedid, Bernard Floccard, Guillaume Marcotte, Vanessa Labeye, Maud Rabeyrin, Ricardo Codas, Cécile Chauvet, Philip Robinson, Emmanuel Morelon, Lionel Badet, William Hanf, Thomas Rimmelé
BACKGROUND: Kidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes. METHODS: The primary endpoint was the one-year measured graft filtration rate (mGFR)...
January 8, 2018: BMC Nephrology
B L Phillips, P Chandak, R Uwechue, C van Nispen Tot Pannerden, C Hemsley, C J Callaghan
No abstract text is available yet for this article.
January 3, 2018: Transplantation
Alix P M Matton, Laura C Burlage, Rianne van Rijn, Yvonne de Vries, Shanice A Karangwa, Maarten W Nijsten, Annette S H Gouw, Janneke Wiersema-Buist, Jelle Adelmeijer, Andrie C Westerkamp, Ton Lisman, Robert J Porte
BACKGROUND: Normothermic machine perfusion (NMP) enables viability assessment of donor livers prior to transplantation. NMP is frequently performed using human blood products including red blood cells (RBC) and fresh frozen plasma (FFP). Our aim was to examine the efficacy of a novel machine perfusion solution based on polymerized bovine hemoglobin HBOC-201. METHODS: Twenty-four livers declined for transplantation were transported using static cold storage. Upon arrival, livers underwent NMP for 6 hours using pressure-controlled portal and arterial perfusion...
December 27, 2017: Liver Transplantation
Michael K Hsin, Ricardo Zamel, Marcelo Cypel, David Wishart, Beomsoo Han, Shaf Keshavjee, Mingyao Liu
OBJECTIVE: To identify potential biomarkers during ex vivo lung perfusion (EVLP) using metabolomics approach. SUMMARY BACKGROUND DATA: EVLP increases the number of usable donor lungs for lung transplantation (LTx) by physiologic assessment of explanted marginal lungs. The underlying paradigm of EVLP is the normothermic perfusion of cadaveric lungs previously flushed and stored in hypothermic preservation fluid, which allows the resumption of active cellular metabolism and respiratory function...
January 2018: Annals of Surgery
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