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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
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A Review of Machine Perfusion Strategies in Liver Transplantation
Amay Banker1, Neha Bhatt1, Prashantha S Rao1
1Department of Liver Transplant and HPB Surgery, Sir HN Reliance Foundation Hospital, Mumbai, India.
Journal of Clinical and Experimental Hepatology
|March 23, 2023
Summary
Machine perfusion (MP) offers improved liver preservation for marginal donor allografts compared to static cold storage (SCS). This technique enhances viability assessment and allows for allograft reconditioning, expanding donor organ availability for liver transplantation.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Preservation
Background:
- Liver transplantation is standard for end-stage liver disease, but donor allograft shortage is critical.
- Expanded donor criteria (extended criteria donors, donation after circulatory death) increase the risk of injury with standard static cold storage (SCS).
- Optimizing organ preservation is crucial for marginal livers.
Purpose of the Study:
- To review machine perfusion (MP) in liver allograft preservation.
- To emphasize current trends in clinical MP applications.
- To discuss future potential of ex vivo therapeutics.
Main Methods:
- Review of clinical trials on hypothermic MP, normothermic MP, hypothermic oxygenated MP, and controlled oxygenated rewarming.
- Discussion of advancements in MP for expanded donor livers.
- Exploration of ex vivo therapeutics for allograft optimization.
Main Results:
- MP strategies offer advantages over SCS, including longer preservation times and viability assessment.
- MP provides potential for reconditioning high-risk allografts before implantation.
- Significant advancements in MP for liver allograft preservation have occurred.
Conclusions:
- Machine perfusion is a promising technique for preserving marginal liver allografts.
- MP offers superior outcomes compared to traditional static cold storage.
- Future research may further enhance allograft quality through MP and ex vivo therapeutics.
Keywords:
ALP, Alkaline phosphataseALT, Alanine transaminaseASO, Antisense oligonucleotidesAST, Aspartate transaminaseCIT, Cold ischemia timesCOPE, Consortium for Organ Preservation in EuropeCOR, Controlled oxygenated rewarmingDBD, Donation after brain deathDCD, Donation after circulatory deathDHOPE, dual hypothermic oxygenated machine perfusionEAD, Early allograft dysfunctionECD, Extended criteria donorsETC, Electron transport chainGGT, Gamma glutamyl transferaseHCV, Hepatitis C virusHMP, Hypothermic machine perfusionHOPE, Hypothermic oxygenated machine perfusionICU, Intensive care unitIGL, Institute George Lopez-1INR, International normalized ratioIRI, ischemia reperfusion injuryLDH, Lactate dehydrogenaseMELD, Model for end-stage liver diseaseMP, Machine perfusionNAS, Non-anastomotic biliary stricturesNMP, Normothermic machine perfusionNO, Nitric oxidePNF, Primary nonfunctionROS, Reactive oxygen speciesRT-PCR, Reverse transcription polymerase chain reactionSNMP, Sub-normothermic machine perfusionUW, University of WisconsinWIT, Warm ischemia timeshypothermic machine perfusionhypothermic oxygenated machine perfusionmachine perfusionnormothermic machine perfusionstatic cold storage
