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Bone Marrow Sampling and Transplants01:22

Bone Marrow Sampling and Transplants

Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
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Machine Perfusion as a Strategy to Decrease Ischemia-Reperfusion Injury and Lower Cancer Recurrence Following Liver

Karla Bracho Garcia1, Ahmed Hussein1, Sangeeta Satish2,3

  • 1Department of Liver Transplantation, Cleveland Clinic Weston Hospital, Weston, FL 33331, USA.

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Liver transplantation (LT) can improve survival but cancer recurrence remains high. Machine perfusion techniques like normothermic (NMP) and hypothermic oxygenated (HOPE) may reduce recurrence by mitigating ischemia-reperfusion injury (IRI).

Keywords:
disease-free survivalhepatocellular carcinomahypothermic oxygenated machine perfusion (HOPE)ischemia-reperfusion injuryliver transplantationmicroenvironmentmitochondrial injurynormothermic machine perfusiontumor recurrence

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Area of Science:

  • Hepatobiliary surgery
  • Transplant immunology
  • Oncology

Background:

  • Liver transplantation (LT) is crucial for liver cancer, yet cancer recurrence is a significant challenge.
  • Ischemia-reperfusion injury (IRI) exacerbates inflammation and mitochondrial dysfunction, promoting tumor recurrence post-LT.
  • Machine perfusion (MP) is emerging as a method to improve organ quality and outcomes in LT.

Purpose of the Study:

  • To explore the link between IRI-induced inflammation and cancer recurrence after LT.
  • To evaluate machine perfusion strategies, specifically NMP and HOPE, in mitigating cancer recurrence risk.
  • To review current literature and ongoing trials on MP's role in reducing post-LT cancer recurrence.

Main Methods:

  • Literature screening focused on IRI, inflammation, and cancer recurrence in LT.
  • Analysis of machine perfusion techniques (NMP, HOPE) and their impact on IRI.
  • Review of retrospective and prospective studies on MP for reducing hepatocellular carcinoma recurrence.

Main Results:

  • IRI creates a pro-inflammatory microenvironment that favors tumor recurrence.
  • Retrospective studies suggest upfront NMP and end-ischemic HOPE reduce hepatocellular carcinoma recurrence.
  • Three prospective randomized controlled trials are underway to validate HOPE's efficacy.

Conclusions:

  • Reducing IRI and mitochondrial dysfunction via MP may decrease cancer recurrence after LT.
  • NMP and HOPE show promise in mitigating IRI and improving outcomes in LT for cancer patients.
  • Further robust evidence from ongoing trials is needed to confirm the benefits of MP in reducing LT cancer recurrence.