Clinical Implementation of Prolonged Liver Preservation and Monitoring Through Normothermic Machine Perfusion in Liver Transplantation
| Autor: | Stefan Schneeberger, Thomas Resch, Manuel Maglione, Christopher J.E. Watson, Alois Obwegeser, Rupert Oberhuber, Benno Cardini, Werner Pajk, Theresa Hautz, Judith Martini, Stefan Scheidl, Christian Margreiter, Herbert Tilg, Marion Frank, Florian Augustin, Annemarie Weissenbacher, Andrea Griesmacher, Claudia Bösmüller, Margot Fodor, Stephan Eschertzhuber, Harald Schennach, Robert Breitkopf, Dietmar Öfner, Harald Mair |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Aged 80 and over Transplantation Machine perfusion medicine.medical_specialty Time Factors business.industry medicine.medical_treatment Graft Survival Patient survival Organ Preservation Middle Aged Liver transplantation Clinical routine Extended criteria Liver Transplantation Surgery Perfusion medicine Humans business Liver preservation Blood bank Aged |
| Zdroj: | Transplantation. 104:1917-1928 |
| ISSN: | 0041-1337 |
| Popis: | Background Normothermic machine perfusion (NMP) bears the potential for significant prolongation of liver preservation before transplantation. Although safety and feasibility have been recently published, no data are available describing the significant challenges of establishing NMP programs outside clinical studies. We herein present our experience and propose a multidisciplinary approach for liver NMP in the clinical routine. Methods In February 2018, liver NMP was introduced for routine use in marginal organs, logistic challenges, and complex recipients at our institution. In a multidisciplinary effort among transplant coordinators, perfusionists, transplant surgeons, anesthesia, nurses, blood bank as well as laboratory staff, a clinical routine was established and 34 NMP cases were performed without critical incidents or organ loss. Results Nine livers were discarded due to poor organ quality and function observed during NMP. Twenty-five livers were successfully transplanted after preservation of up to 38 h. The extended criteria donors rate was 100% and 92% in discarded and transplanted livers, respectively. Nighttime procedures and parallel transplantations were eventually omitted. Graft and patient survival was 88% at 20 mo. No cholangiopathy was observed despite the use of extended criteria donor organs in 92% of cases. Conclusions NMP in a multidisciplinary approach enables a safe prolongation of liver preservation and overnight organ care. A first field test of NMP indicates safety and benefit of this approach. |
| Databáze: | OpenAIRE |
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