scholarly journals Normothermic Machine Perfusion versus Cold Storage of Liver in Pig Model: A Meta-Analysis

2018 ◽  
Vol 23 ◽  
pp. 197-206 ◽  
Author(s):  
Shiqi Bian ◽  
Zhijun Zhu ◽  
Liying Sun ◽  
Lin Wei ◽  
Wei Qu ◽  
...  
Keyword(s):  
Cold Storage ◽  
Meta Analysis ◽  
Pig Model ◽  
Machine Perfusion ◽  
Normothermic Machine Perfusion

scholarly journals Normothermic Ex Vivo Machine Perfusion for Liver Grafts Recovered from Donors after Circulatory Death: A Systematic Review and Meta-Analysis

HPB Surgery ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jordan J. Nostedt ◽  
Daniel T. Skubleny ◽  
A. M. James Shapiro ◽  
Sandra Campbell ◽  
Darren H. Freed ◽  
...  
Keyword(s):  
Cold Storage ◽  
Meta Analysis ◽  
Mean Difference ◽  
Large Animal ◽  
Machine Perfusion ◽  
Donation After Circulatory Death ◽  
Economic Implications ◽  
Normothermic Perfusion ◽  
Normothermic Machine Perfusion ◽  
Circulatory Death

As a result of donation after circulatory death liver grafts’ poor tolerance to cold storage, there has been increasing research interest in normothermic machine perfusion. This study aims to systematically review the current literature comparing normothermic perfusion to cold storage in donation after circulatory death liver grafts and complete a meta-analysis of published large animal and human studies. A total of nine porcine studies comparing cold storage to normothermic machine perfusion for donation after circulatory death grafts were included for analysis. There was a significant reduction in AST (mean difference −2291 U/L, CI (−3019, −1563); P ≤ 0.00001) and ALT (mean difference −175 U/L, CI (−266, −85); P=0.0001), for normothermic perfusion relative to static cold storage, with moderate (I2 = 61%) and high (I2 = 96%) heterogeneity, respectively. Total bile production was also significantly higher (mean difference = 174 ml, CI (155, 193); P≤0.00001). Further research focusing on standardization, performance of this technology following periods of cold storage, economic implications, and clinical trial data focused on donation after circulatory death grafts will be helpful to advance this technology toward routine clinical utilization for these grafts.

scholarly journals The effect of blood cells retained in rat livers during static cold storage on viability outcomes during normothermic machine perfusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Omar Haque ◽  
Casie A. Pendexter ◽  
Benjamin T. Wilks ◽  
Ehab O. A. Hafiz ◽  
James F. Markmann ◽  
...  
Keyword(s):  
Cold Storage ◽  
Blood Cells ◽  
Energy Charge ◽  
Ischemic Injury ◽  
Machine Perfusion ◽  
University Of Wisconsin ◽  
Normothermic Machine Perfusion ◽  
Preservation Solutions ◽  
Positive Correlations ◽  
Rat Livers

AbstractIn transplantation, livers are transported to recipients using static cold storage (SCS), whereby livers are exposed to cold ischemic injury that contribute to post-transplant risk factors. We hypothesized that flushing organs during procurement with cold preservation solutions could influence the number of donor blood cells retained in the allograft thereby exacerbating cold ischemic injury. We present the results of rat livers that underwent 24 h SCS after being flushed with a cold University of Wisconsin (UW) solution versus room temperature (RT) lactated ringers (LR) solution. These results were compared to livers that were not flushed prior to SCS and thoroughly flushed livers without SCS. We used viability and injury metrics collected during normothermic machine perfusion (NMP) and the number of retained peripheral cells (RPCs) measured by histology to compare outcomes. Compared to the cold UW flush group, livers flushed with RT LR had lower resistance, lactate, AST, and ALT at 6 h of NMP. The number of RPCs also had significant positive correlations with resistance, lactate, and potassium levels and a negative correlation with energy charge. In conclusion, livers exposed to cold UW flush prior to SCS appear to perform worse during NMP, compared to RT LR flush.

scholarly journals Machine Perfusion in Liver Transplantation: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Matas Jakubauskas ◽  
Lina Jakubauskiene ◽  
Bettina Leber ◽  
Kestutis Strupas ◽  
Philipp Stiegler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Meta Analysis ◽  
Biliary Complication ◽  
Liver Graft ◽  
Machine Perfusion ◽  
Biliary Strictures ◽  
Normothermic Machine Perfusion ◽  
Organ Quality ◽  
End Stage

<b><i>Background:</i></b> Liver transplantation (LTx) is the only treatment option for patients with end-stage liver disease. Novel organ preservation techniques such as hypothermic machine perfusion (HMP) or normothermic machine perfusion (NMP) are under investigation in order to improve organ quality from extended criteria donors and donors after circulatory death. The aim of this study was to systematically review the literature reporting LTx outcomes using NMP or HMP compared to static cold storage (SCS). <b><i>Methods:</i></b> The following data were retrieved: graft primary nonfunction rate, early allograft dysfunction (EAD) rate, biliary complication rate, and 12-month graft and patient survival. A total of 15 studies were included (6 NMP and 9 HMP studies), and meta-analysis was performed only for HMP studies because NMP had considerable differences. <b><i>Results:</i></b> The systematic review showed the potential of NMP to reduce graft injury and lower the liver graft discard rate. The performed quantitative analyses showed that the use of HMP reduces the rate of EAD (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34–0.76; <i>p</i> = 0.001; <i>I</i><sup>2</sup> = 0%) and non-anastomotic biliary strictures (OR 0.34; 95% CI 0.17–0.67; <i>p</i> = 0.002; <i>I</i><sup>2</sup> = 0%) compared to SCS. <b><i>Conclusion:</i></b> Our systematic review and meta-analysis revealed that the use of HMP reduces the rate of EAD and non-anastomotic biliary strictures compared to SCS.

Machine perfusion versus cold storage of livers: a meta-analysis

2016 ◽  
Vol 10 (4) ◽  
pp. 451-464 ◽  
Author(s):  
Sushun Liu ◽  
Qing Pang ◽  
Jingyao Zhang ◽  
Mimi Zhai ◽  
Sinan Liu ◽  
...  
Keyword(s):  
Cold Storage ◽  
Meta Analysis ◽  
Machine Perfusion

scholarly journals Development of ex vivo normothermic perfusion as an innovative method to assess pancreases after preservation

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Ann Ogbemudia
Keyword(s):  
Cold Storage ◽  
Ex Vivo ◽  
Gas Analysis ◽  
Machine Perfusion ◽  
Assessment Strategy ◽  
Hypothermic Machine Perfusion ◽  
Normothermic Perfusion ◽  
Pancreas Preservation ◽  
Normothermic Machine Perfusion ◽  
Lactate Levels

Ann Ogbemudia, Julien Branchereau (Joint first authors), Gabriella Hakim, Fungai Dengu, FaysalEl-Gilani, John Mulvey, Kaithlyn Rozenberg, Thomas Prudhomme, Letizia Lo Faro, James Hunter,Paul Johnson, Rutger Ploeg and Peter Friend   Objective Static cold storage (SCS) is the standard method for pancreas preservation but does not facilitate objective organ assessment prior to transplantation. Normothermic machine perfusion (NMP) has been used to test other abdominal and thoracic organs’ function and viability in transplantation settings. Our aim was to develop a NMP protocol specific for pancreases and then investigate its potential as an organ assessment strategy. Method 8 porcine pancreases were procured in conditions replicating donation after circulatory death with warm ischaemia time of 25 minutes. After 3 hours of static cold storage (SCS) the pancreases were divided into 3 experimental groups 1) the feasibility group (n=2) that underwent 2.5 hours of NMP 2) the SCS group (n = 2) that underwent an additional 6 hours of SCS prior to assessment on NMP for an hour and 3) the Oxygenated Hypothermic Machine Perfusion (oxyHMP) group (n = 4) that underwent 6 hours of oxyHMP followed by 1-hour assessment on NMP. The NMP protocol used autologous, leucodepleted blood delivered at a mean arterial pressure of 40mmHg with a temperature of 37oC. At timed intervals during NMP, perfusate samples were collected for gas analysis and perfusion parameters were recorded. Results The feasibility group was used to develop the NMP protocol and demonstrated stable perfusion parameters throughout NMP. Compared to the SCS group the oxyHMP group demonstrated better average perfusion characteristics with lower resistances, higher flow rates, lower mean lactate levels and physiological pH. The oxyHMP group maintained normal macroscopic appearances during NMP. At the end of NMP the SCS group had an average 32% weight increase compared to the oxyHMP group that were found to have a 17% weight reduction. Conclusion Normothermic machine perfusion of whole pancreases is feasible after cold preservation and potentially useful as an assessment strategy. Furthermore, it demonstrated that oxygenated HMP may be beneficial for pancreas preservation compared to SCS.

scholarly journals Optimizing Livers for Transplantation Using Machine Perfusion versus Cold Storage in Large Animal Studies and Human Studies: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Xinan Jiang ◽  
Lei Feng ◽  
Mingxin Pan ◽  
Yi Gao
Keyword(s):  
Hyaluronic Acid ◽  
Cold Storage ◽  
Animal Studies ◽  
Meta Analysis ◽  
Human Studies ◽  
Large Animal ◽  
Machine Perfusion ◽  
Early Graft ◽  
Meta Analyses ◽  
Early Graft Dysfunction

Background. Liver allograft preservation frequently involves static cold storage (CS) and machine perfusion (MP). With its increasing popularity, we investigated whether MP was superior to CS in terms of beneficial outcomes. Methods. Human studies and large animal studies that optimized livers for transplantation using MP versus CS were assessed (PubMed/Medline/EMBASE). Meta-analyses were conducted for comparisons. Study quality was assessed according to the Newcastle-Ottawa quality assessment scale and SYRCLE’s risk of bias tool. Results. Nineteen studies were included. Among the large animal studies, lower levels of lactate dehydrogenase (SMD -3.16, 95% CI -5.14 to -1.18), alanine transferase (SMD -2.46, 95% CI -4.03 to -0.90), and hyaluronic acid (SMD -2.48, 95% CI -4.21 to -0.74) were observed in SNMP-preserved compared to CS-preserved livers. NMP-preserved livers showing lower level of hyaluronic acid (SMD -3.97, 95% CI -5.46 to -2.47) compared to CS-preserved livers. Biliary complications (RR 0.45, 95% CI 0.28 to 0.73) and early graft dysfunction (RR 0.56, 95% CI 0.34 to 0.92) also significantly reduced with HMP preservation in human studies. No evidence of publication bias was found. Conclusions. MP preservation could improve short-term outcomes after transplantation compared to CS preservation. Additional randomized controlled trials (RCTs) are needed to develop clinical applications of MP preservation.

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