“In 10 years” of debate: Pro-machine perfusion for liver preservation will be universal

2016 ◽  
Vol 22 (S1) ◽  
pp. 25-28 ◽  
Author(s):  
R. Cutler Quillin ◽  
James V. Guarrera
Keyword(s):  
Machine Perfusion ◽  
Liver Preservation

scholarly journals Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

10.3791/52777 ◽  
2015 ◽  
Author(s):  
Bote G. Bruinsma ◽  
James H. Avruch ◽  
Pepijn D. Weeder ◽  
Gautham V. Sridharan ◽  
Basak E. Uygun ◽  
...  
Keyword(s):  
Human Liver ◽  
Machine Perfusion ◽  
Liver Preservation

scholarly journals Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials

2020 ◽  
Vol 40 (03) ◽  
pp. 264-281 ◽  
Author(s):  
E. Bonaccorsi-Riani ◽  
I.M.A. Brüggenwirth ◽  
J.E. Buchwald ◽  
S. Iesari ◽  
P.N. Martins
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Correct Trial ◽  
Gold Standard Method ◽  
Liver Preservation ◽  
Mature Phase ◽  
Normothermic Machine Perfusion ◽  
Human Livers

AbstractMachine perfusion (MP) preservation is potentially one of the most significant improvements in the field of liver transplantation in the last 20 years, and it has been considered a promising strategy for improved preservation and ex situ evaluation of extended criteria donor (ECD) organs. However, MP preservation adds significant cost and logistical considerations to liver transplantation. MP protocols are mainly classified according to the perfusion temperature with hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) being the two categories most studied so far. After extensive preclinical work, MP entered the clinical setting, and there are now several studies that demonstrated feasibility and safety. However, because of the limited quality of clinical trials, there is no compelling evidence of superiority in preservation quality, and liver MP is still considered experimental in most countries. MP preservation is moving to a more mature phase, where ongoing and future studies will bring new evidence in order to confirm their superiority in terms of clinical outcomes, organ utilization, and cost-effectiveness. Here, we present an overview of all preclinical MP studies using discarded human livers and liver MP clinical trials, and discuss their results. We describe the different perfusion protocols, pitfalls in MP study design, and provide future perspectives. Recent trials in liver MP have revealed unique challenges beyond those seen in most clinical studies. Randomized trials, correct trial design, and interpretation of data are essential to generate the data necessary to prove if MP will be the new gold standard method of liver preservation.

Liver preservation with HTK: salutary effect of hypothermic aerobiosis by either gaseous oxygen or machine perfusion

2002 ◽  
Vol 16 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Thomas Minor ◽  
Peter Olschewski ◽  
Rene H Tolba ◽  
Susanne Akbar ◽  
Mariana Kocalkova ◽  
...  
Keyword(s):  
Machine Perfusion ◽  
Gaseous Oxygen ◽  
Liver Preservation ◽  
Salutary Effect

scholarly journals Improved rat liver preservation by hypothermic continuous machine perfusion using polysol, a new, enriched preservation solution

2005 ◽  
Vol 11 (5) ◽  
pp. 539-546 ◽  
Author(s):  
Maud Bessems ◽  
Benedict M. Doorschodt ◽  
Arl�ne K. van Vliet ◽  
Thomas M. van Gulik
Keyword(s):  
Rat Liver ◽  
Machine Perfusion ◽  
Preservation Solution ◽  
Liver Preservation

scholarly journals Donor Warm Ischemia Time in DCD Liver Transplantation—Working Group Report From the ILTS DCD, Liver Preservation, and Machine Perfusion Consensus Conference

2021 ◽  
Vol 105 (6) ◽  
pp. 1156-1164
Author(s):  
Marit Kalisvaart ◽  
Kristopher P. Croome ◽  
Roberto Hernandez-Alejandro ◽  
Jacques Pirenne ◽  
Miriam Cortés-Cerisuelo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Working Group ◽  
Consensus Conference ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Machine Perfusion ◽  
Liver Preservation ◽  
Ischemia Time ◽  
Group Report

scholarly journals Normothermic Machine Perfusion (NMP) of the Liver as a Platform for Therapeutic Interventions during Ex-Vivo Liver Preservation: A Review

2020 ◽  
Vol 9 (4) ◽  
pp. 1046 ◽  
Author(s):  
Fungai Dengu ◽  
Syed Hussain Abbas ◽  
Georg Ebeling ◽  
David Nasralla
Keyword(s):  
Ex Vivo ◽  
Organ Donor ◽  
Therapeutic Interventions ◽  
Machine Perfusion ◽  
Real Potential ◽  
Ischaemia Reperfusion Injury ◽  
Donor Pool ◽  
Liver Preservation ◽  
Ischaemia Reperfusion ◽  
Normothermic Machine Perfusion

Liver transplantation is increasingly dependent on the use of extended criteria donors (ECD) to increase the organ donor pool and address rising demand. This has necessitated the adoption of innovative technologies and strategies to protect these higher-risk grafts from the deleterious effects of traditional preservation and ischaemia reperfusion injury (IRI). The advent of normothermic machine perfusion (NMP) and rapid growth in the clinical adoption of this technology has accelerated efforts to utilise NMP as a platform for therapeutic intervention to optimise donor livers. In this review we will explore the emerging preclinical data related to ameliorating the effects of IRI, protecting the microcirculation and reducing the immunogenicity of donor organs during NMP. Exploiting the window of opportunity afforded by NMP, whereby the liver can be continuously supported and functionally assessed while therapies are directly delivered during the preservation period, has clear logistical and theoretical advantages over current preservation methods. The clinical translation of many of the therapeutic agents and strategies we will describe is becoming more feasible with widespread adaptation of NMP devices and rapid advances in molecular biology and gene therapy, which have substantially improved the performance of these agents. The delivery of novel therapeutics during NMP represents one of the new frontiers in transplantation research and offers real potential for successfully tackling fundamental challenges in transplantation such as IRI.

scholarly journals A novel model for ex situ reperfusion of the human liver following subnormothermic machine perfusion

TECHNOLOGY ◽  
2017 ◽  
Vol 05 (04) ◽  
pp. 196-200 ◽  
Author(s):  
James H. Avruch ◽  
Bote G. Bruinsma ◽  
Pepijn D. Weeder ◽  
Gautham V. Sridharan ◽  
Robert J. Porte ◽  
...  
Keyword(s):  
Human Liver ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Human Donor ◽  
Liver Preservation ◽  
Atp Levels ◽  
Preservation Method ◽  
Human Livers ◽  
Novel Model ◽  
Bile Production

Machine perfusion-based organ preservation techniques are prudently transitioning into clinical practice. Although experimental data is compelling, the outcomes in the highly variable clinical donation-transplantation setting are unpredictable. Here, we offer an intermediate tool for pre-clinical assessment of human donor livers. We present a model for ex situ reperfusion of discarded human livers and report on its application in three human livers that have undergone subnormothermic (21[Formula: see text]C) machine perfusion as an experimental preservation method. During reperfusion, the livers macroscopically reperfused in the first 15 minutes, and remained visually well-perfused for 3 hours of ex situ reperfusion. Bile production and oxygen consumption were observed throughout ex situ reperfusion. ATP levels increased 4.25-fold during SNMP. Between the end of SNMP and the end of reperfusion ATP levels dropped 45%. ALT levels in blood increased rapidly in the first 30 minutes and ALT release continued to taper off towards the end of perfusion. Release of CRP, TNF-[Formula: see text], IL-1[Formula: see text], and IL-12, IFN-[Formula: see text] was sustained during reperfusion. These findings support the use of this model for the evaluation of novel human liver preservation techniques.

scholarly journals Liver Preservation With Machine Perfusion and a Newly Developed Cell‐Free Oxygen Carrier Solution Under Subnormothermic Conditions

2015 ◽  
Vol 15 (2) ◽  
pp. 381-394 ◽  
Author(s):  
P. Fontes ◽  
R. Lopez ◽  
A. van der Plaats ◽  
Y. Vodovotz ◽  
M. Minervini ◽  
...  
Keyword(s):  
Oxygen Carrier ◽  
Machine Perfusion ◽  
Carrier Solution ◽  
Free Oxygen ◽  
Liver Preservation
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