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Ex Situ Normothermic Machine Perfusion of Donor Livers
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Donor pretreatment and machine perfusion: current views.

Stephen O'Neill1, Gabriel C Oniscu1,2

  • 1Edinburgh Transplant Centre, Royal Infirmary of Edinburgh.

Current Opinion in Organ Transplantation
|December 14, 2019
PubMed
Summary
This summary is machine-generated.

Research on donor pretreatment and machine perfusion in kidney transplantation is needed. Normothermic regional perfusion shows promise for donation after circulatory death, while hypothermic machine perfusion benefits deceased donor transplants.

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Area of Science:

  • Nephrology
  • Transplantation immunology
  • Surgical innovation

Background:

  • Kidney transplantation outcomes are significantly impacted by donor management and organ preservation techniques.
  • Donation after circulatory death (DCD) kidney transplantation presents unique challenges, including higher risks of delayed graft function (DGF) and graft failure.
  • Established deceased donor kidney transplantation protocols require ongoing refinement to optimize graft survival.

Purpose of the Study:

  • To review recent advancements in donor pretreatment strategies for kidney transplantation.
  • To summarize the current evidence on machine perfusion techniques in kidney preservation.
  • To identify research gaps and future directions in donor optimization and organ perfusion.

Main Methods:

  • Systematic review of recently published studies on donor pretreatment and machine perfusion.
  • Analysis of clinical trial data and observational studies.
  • Synthesis of findings related to graft function, delayed graft function, and graft survival.

Main Results:

  • Normothermic regional perfusion (NRP) demonstrates improved graft function and survival in uncontrolled DCD kidney transplantation.
  • Hypothermic machine perfusion (HMP) effectively reduces DGF in deceased donor kidney transplantation across various donor types.
  • Oxygenated HMP shows potential in mitigating acute rejection in controlled DCD kidney transplantation.
  • Ex-situ normothermic perfusion is an emerging technique with potential for facilitating donor pretreatment delivery.

Conclusions:

  • Randomized controlled trials (RCTs) are crucial to advance donor pretreatment research and define the role of specific preservation techniques.
  • NRP is a promising strategy for high-risk DCD kidney allografts.
  • Further research is needed to optimize HMP protocols and explore novel perfusion techniques for enhanced kidney allograft outcomes.