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Preservation of Organs to Be Transplanted: An Essential Step in the Transplant Process
Maryne Lepoittevin1,2,3, Sébastien Giraud1,2,3, Thomas Kerforne2,3,4
1Biochemistry Department, CHU Poitiers, 86021 Poitiers, France.
Abstract:
Organ transplantation remains the treatment of last resort in case of failure of a vital organ (lung, liver, heart, intestine) or non-vital organ (essentially the kidney and pancreas) for which supplementary treatments exist. It remains the best alternative both in terms of quality-of-life and life expectancy for patients and of public health expenditure. Unfortunately, organ shortage remains a widespread issue, as on average only about 25% of patients waiting for an organ are transplanted each year. This situation has led to the consideration of recent donor populations (deceased by brain death with extended criteria or deceased after circulatory arrest). These organs are sensitive to the conditions of conservation during the ischemia phase, which have an impact on the graft's short- and long-term fate. This evolution necessitates a more adapted management of organ donation and the optimization of preservation conditions. In this general review, the different aspects of preservation will be considered. Initially done by hypothermia with the help of specific solutions, preservation is evolving with oxygenated perfusion, in hypothermia or normothermia, aiming at maintaining tissue metabolism. Preservation time is also becoming a unique evaluation window to predict organ quality, allowing repair and/or optimization of recipient choice.
Insights
Organ transplantation faces organ shortage, driving use of extended criteria donors. New preservation methods optimize organ quality and recipient matching for better transplant outcomes.
Area of Science:
- Transplantation immunology
- Organ preservation science
- Regenerative medicine
Background:
- Organ transplantation is a life-saving treatment for organ failure, but faces a critical shortage of available organs.
- Limited donor availability necessitates the use of organs from extended criteria donors (ECD) and donation after circulatory death (DCD) donors.
- These organs are more susceptible to preservation-related injury, impacting graft survival.
Purpose of the Study:
- To review current and emerging strategies for organ preservation in transplantation.
- To highlight the importance of optimizing preservation conditions for extended criteria donor organs.
- To discuss the evolving role of preservation time as an assessment window for organ quality.
Main Methods:
- Review of existing literature on organ preservation techniques, including hypothermic storage and machine perfusion.
- Analysis of studies investigating oxygenated perfusion in hypothermia and normothermia.
- Examination of methods for evaluating organ quality during the preservation period.
Main Results:
- Hypothermic preservation with solutions is the traditional method, but oxygenated perfusion offers improved metabolic support.
- Normothermic and hypothermic machine perfusion can maintain tissue viability and potentially repair injury.
- Preservation time is increasingly used to assess graft viability and inform recipient selection.
Conclusions:
- Advances in organ preservation are crucial for expanding the donor pool and improving transplant success rates.
- Machine perfusion techniques offer a promising approach to enhance organ quality and extend preservation times.
- Optimized preservation strategies, coupled with improved organ assessment, are key to addressing the organ shortage crisis.
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