Promise of Normothermia

AbstractPurpose of this ReviewNormothermic ex vivo machine perfusion (NMP) is a novel preservation modality that has been investigated as a tool to preserve and protect organs from extended criteria donors (ECDs). This review summarizes the latest clinical and experimental progress in this field and tries to answer questions such as what are the future implications of NMP, what are its therapeutic potentials, and what are the limitations associated with this technology?Recent FindingsNew emerging data from clinical trials with NMP devices have demonstrated the safety and feasibility of this technology as well as its ability to preserve allograft function during the preservation period.SummaryNMP provides potential solutions to limitations associated with the standard cold preservation modality. It maintains the allografts in a physiological state, prevents depletion of cellular energy sources, enables resuscitation and assessment of the ECD organ, and opens the door for future ex vivo therapeutic interventions. Hence, it should increase donor pool and positively impact transplant outcomes.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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AbstractPurpose of ReviewIn this review, we aim to introduce the concept of machine perfusion of vascularized composite allografts (VCAs). We briefly discuss the basic elements of the circuit design, role of the temperature during the perfusion, types of perfusate, and future trends in this field.Recent FindingsSeveral large animal models have demonstrated the efficacy of machine perfusion over static cold storage. While the maximum allowable ischemia time in VCA is 4 –6 h with cold storage method, promising results have been achieved in extended preservation times up to 24 h in machine perfusion technique....
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research
Conclusions We present a quick, simple, and affordable method to decellularize a muscle flap through the vascular network. Our proposed method is efficient and can be completed in a significantly shorter time when compared with other methods. It is also safe and does not affect integrity of tissue, and this is essential for a reliable recellularization.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research
We describe a case of successfully ex vivo treated and transplanted human lung allografts.MethodsDonor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery.ResultsWe successfully implanted our ex vivo treated organs.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: NEW TECHNOLOGIES Source Type: research
Conclusions: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.
Source: Annals of Surgery - Category: Surgery Tags: ESA PAPERS Source Type: research
Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant. Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes, the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al present 10-year outcomes of the Toronto Lung Transplant Group &rs...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
In this study, we investigated the long-term effects of the HESP on skeletal muscle metabolism, structure, and force generation and compared it with the current standard of preservation. Methods. Forty male Lewis rats (250 ± 25 g) were divided into 5 groups, including naive control, sciatic nerve transection or repair, immediate transplantation, SCS, and HESP. For the SCS group, limbs were preserved at 4°C for 6 hours. In the HESP group, limbs were continuously perfused with oxygenated histidine-tryptophan-ketoglutarate (HTK) solution at 10–15°C for 6 hours. Hemodynamic and biochemical parame...
Source: Transplantation - Category: Transplant Surgery Tags: Original Basic Science–General Source Type: research
This study shows that quantitative perfusion of kidney transplants can be evaluated safely during kidney transplantation. DGF being defined as one or more dialyses after kidney transplantation can only be detected postoperatively, however, it may be predicted intraoperatively. PMID: 31559620 [PubMed - as supplied by publisher]
Source: Zentralblatt fur Chirurgie - Category: Surgery Authors: Tags: Zentralbl Chir Source Type: research
This study describes a simple, reproducible, human model that allows for interrogation of flow effects during ex vivo organ perfusion. MATERIALS AND METHODS: Gonadal veins from deceased human renal allografts were subjected to either static cold storage or hypothermic machine perfusion for up to 24 hours. Caspase-3, Krüppel-like factor 2 expression and electron microscopic analysis were compared between 'flow' and 'no-flow' conditions, with living donor gonadal vein sections serving as negative controls. RESULTS: The increase in caspase-3 expression was less pronounced for hypothermic machine-perfused veins ...
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Conclusions. Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
CONCLUSIONS Non-invasive investigations of the liver microcirculation and hemoglobin oxygenation were shown to be predictive factors for EAD following liver transplantation. PMID: 31417074 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
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