From “Gut Feeling” to Objectivity: Machine Preservation of the Liver as a Tool to Assess Organ Viability

AbstractPurpose of ReviewThe purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers.Recent FindingsIn both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo. Lactate clearance, glucose evolution and pH regulation during normothermic perfusion seem promising measures of viability. In addition, bile chemistry might inform on cholangiocyte viability and the likelihood of post-transplant cholangiopathy.SummaryWhile the use of machine perfusion technology has the potential to reduce and even remove uncertainty regarding liver graft viability, analysis of large datasets, such as those derived from large multicenter trials of machine perfusion, are needed to provide sufficient information to enable viability parameters to be defined and validated .
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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ConclusionsAttempting to meet the demand for livers, transplant centers are increasingly turning to living donor liver transplantation, protocols such as HCV-positive to HCV-negative transplants, and machine perfusion of marginal organs.
Source: Abdominal Imaging - Category: Radiology Source Type: research
A Swiss collaboration of clinical researchers from University Hospital Zurich, ETH Zurich, Wyss Zurich, and the University of Zurich has created a machine that can keep human livers alive for up to a week. For comparison, current methods of perfusion...
Source: Medgadget - Category: Medical Devices Authors: Tags: Surgery Source Type: blogs
CONCLUSIONS Splitting the liver under machine perfusion preservation may help restore the function and reduce ischemia-reperfusion injury. PMID: 31932575 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
In conclusion, we established effective, robust and fast decellularization protocols for both porcine and human livers. With this protocol the duration of decellularization for whole-organ human livers has been shortened considerably. The increased pressure and flow did not damage the ECM, as major ECM components remained intact. PMID: 31923991 [PubMed - in process]
Source: Appl Human Sci - Category: Physiology Authors: Tags: Mater Sci Eng C Mater Biol Appl Source Type: research
AbstractContrast-enhanced ultrasound (CEUS) is gaining ever-increasing acceptance in the preoperative and postoperative evaluation of liver-transplanted patients. While indications are still a matter of research, CEUS is used in tertiary centers to supplement ultrasound (US) and Color Doppler US examination, with the potential of providing a comprehensive first-line ultrasound-based diagnosis. Alternatively, CEUS is used as a problem-solving tool when previous cross-sectional or US imaging was inconclusive, especially in assessing hepatocellular carcinoma, parenchymal perfusion abnormalities, the vascular status, and even ...
Source: Abdominal Imaging - Category: Radiology Source Type: research
ConclusionsThe described procedure is feasible only for surgeons with a transplantation background. The study showed that this translational approach enhances the surgeon ’s ability to perform the intervention systematically in a shorter time and with a good outcome.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
No abstract available
Source: Transplantation - Category: Transplant Surgery Tags: Letters Source Type: research
No abstract available
Source: Transplantation - Category: Transplant Surgery Tags: Letters Source Type: research
No abstract available
Source: Transplantation - Category: Transplant Surgery Tags: In Brief Source Type: research
This study aimed to evaluate whether blocking the TSP1-CD47 signaling pathway could attenuate the acute rejection after liver transplantation. An allogeneic mouse orthotopic liver transplantation model (Balb/c→C3H) with prolonged cold ischemic phase was used to induce severe IRI and lethal acute rejection. CD47mAb or isotype matched-control IgG2a was administered to donor liver during graft perfusion. Recipients were sacrificed at 1d, 3d, 5d and 7d after reperfusion. Blood samples were collected to evaluate serum alanine aminotransferase, total bilirubin, HMGB-1,TNF-α, IL-2 and INF-γ level. Flow cytometric...
Source: Biomedicine and Pharmacotherapy - Category: Drugs & Pharmacology Source Type: research
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