Pushing the Limits: Machine Preservation of the Liver as a Tool to Recondition High-Risk Grafts

AbstractPurpose of the ReviewMachine perfusion (MP) is a novel technology recently introduced in liver transplantation, redefining the current practice of organ preservation and pushing the limits of high-risk liver utilisation. This review highlights the key benefits of machine perfusion over conventional static cold storage (SCS), demonstrated in human liver research and clinical transplants.Recent FindingsThe first clinical trials have demonstrated both safety and feasibility of MP. The most recent transplant series and result from a randomised trial suggest the technology is superior to SCS. The key benefits include extended period of organ preservation, decreased incidence of early allograft dysfunction and reduction of biliary complications. Normothermic liver perfusion allows viability testing to guide transplantability of the highest-risk organs. This technology also provides opportunities for therapeutic interventions to improve liver function and quality in organs that are currently declined for clinical use.SummaryMachine perfusion is likely to transform the liver preservation pathway and to improve utilisation of high-risk grafts.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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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
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
Publication date: Available online 12 July 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Prafulla V. Jadhav, Sunil Raviraj Kothakota, Madhu Sasidharan, Harish Kareem, Ajith K. NairIntroductionIschemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.AimThe aim of this study was to determine the effect of type and grade of donor liv...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Publication date: Available online 12 July 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Prafulla Vishnurao Jadhav, Kothakota Sunil Raviraj, Madhu Sasidharan, Harish Kareem, Ajith K. NairAbstractIntroductionIschemic reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index (DRI), which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.AimTo determine effect of type and grade of donor liver steato...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Conclusions: HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Conclusions. As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research
This study was conducted strictly according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) (Moher et al., 2009). A systematic literature search was performed in Pubmed, Embase, and ISI Web of Science using the medical terminologies described in Table S1, with the language restriction limited to English (updated until 20 January 2019). Details of the search strategy in each database are presented in Table S1. Inclusion Criteria Given the study purpose, we attempted to conduct a broad search that included literature involving continuous risks of all post-operational outcome...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Conclusion As a critical regulator of inflammation and cell survival, the NFκB pathway is a promising target for diagnosing and treating kidney diseases. For modulation of the NFκB pathway in the clinic, a number of molecules can effectively inhibit NFκB signaling by targeting the receptors, associated adaptors, IKKs, IκBs and transcriptional regulators (144). There is further clinical evidence on small-molecule inhibitors of IKKα and NIK from recent trials on anti-cancer therapies (145). These clinical trials showed that the cancer-selective pharmacodynamic response of DTP3, the co-inhibitor...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusions The outcome of DCD organs can be improved by the addition of mcc950 to the perfusate of the HMP system and intravenous injection of mcc950 after transplantation.
Source: Transplantation - Category: Transplant Surgery Tags: Original Basic Science—Liver Source Type: research
In parallel with the pandemic of obesity and diabetes, the prevalence of nonalcoholic fatty liver disease has progressively increased. Nonalcoholic steatohepatitis (NASH), a subtype of nonalcoholic fatty liver disease has also augmented considerably being currently cirrhosis due to NASH the second indication for liver transplantation in the United States. Innovative treatments for NASH have shown promising results in phase 2 studies and are being presently evaluated in phase 3 trials. On the other hand, the high mortality on the liver transplant waitlist and the organ shortage has obligated the transplant centers to consid...
Source: Transplantation - Category: Transplant Surgery Tags: Reviews Source Type: research
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