Normothermic Machine Preservation of the Liver: State of the Art
AbstractPurpose of ReviewThis 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 FindingsNMP 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. Through the ability to perform a viability assessment during preservation and extend preservation times, it is likely that an increase in organ utilisation will follow. NMP may facilitate the enhanced preservation with improved outcomes from donors after cardiac death and steatotic livers. Furthermore, it provides the exciting potential for liver-directed therapeutic interventions.SummaryEvidence to date suggests that NMP facilitates the enhanced preservation of liver grafts with improved early post-transplant outcomes. The key role for this technology is to increase the number and quality of liver grafts available for transplantation and to reduce waiting list deaths.
We present the case of a 60 year old male patient with decompensated liver failure, and critical CAD, who received successful combined off ‐pump coronary bypass grafting without heparin and LT using ex vivo normothermic liver perfusion machine. This approach represents a novel strategy to offer LT to this very selective group of patients.
CONCLUSIONS: Mouse livers showed progressive damage to structure and function during cold storage, with mitochondrial damage perhaps showing the earliest damage. PMID: 31724923 [PubMed - as supplied by publisher]
Condition: Liver Diseases Intervention: Procedure: Liver transplantation of a graft after assessment by normothermic perfusion Sponsor: Assistance Publique - Hôpitaux de Paris Not yet recruiting
A new optimized method for revascularizing bioengineered livers provides up to 15 days of continuous perfusion after transplantation into immunosuppressed pigs.Reuters Health Information
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.
Objective: The aim of this study was to evaluate sequential hypothermic and normothermic machine perfusion (NMP) as a tool to resuscitate and assess viability of initially declined donor livers to enable safe transplantation. Summary Background Data: Machine perfusion is increasingly used to resuscitate and test the function of donor livers. Although (dual) hypothermic oxygenated machine perfusion ([D]HOPE) resuscitates livers after cold storage, NMP enables assessment of hepatobiliary function. Methods: In a prospective clinical trial, nationwide declined livers were subjected to ex situ NMP (viability assessment ...
This study evaluated the application of normothermic regional perfusion to protect the liver grafts from these donors from warm ischemia in a large transplant center in China. MATERIALS AND METHODS: This prospective study involved 19 liver transplants from brain death followed by circulatory death donors that were conducted between December 2014 and June 2017. We evaluated the baseline characteristics of the donors and recipients and compared outcomes of both groups. Graft and recipient survival and postoperative complications were also analyzed. RESULTS: Although the normothermic regional perfusion group consist...
Publication date: Available online 9 October 2019Source: The Lancet Respiratory MedicineAuthor(s): Marcelo Cypel, Jordan J Feld, Marcos Galasso, Rafaela V Pinto Ribeiro, Nikki Marks, Magdalena Kuczynski, Deepali Kumar, Ilona Bahinskaya, Vanderlei S Bagnato, Cristina Kurachi, Arthur S S.sky, Jonathan C Yeung, Laura Donahoe, Marc de Perrot, Kazuhiro Yasufuku, Andrew Pierre, Matthew Binnie, Cecilia Chaparro, Tereza Martinu, Manyin ChenSummaryBackgroundA substantial proportion of organ donors test positive for hepatitis C virus (HCV) infection. To date, only a few studies have evaluated the safety of using lungs from these don...