Transplanting Marginal Organs in the Era of Modern Machine Perfusion and Advanced Organ Monitoring
Autor: | Sefan Schneeberger, Annemarie Weissenbacher, Rupert Oberhuber, Christoph Krapf, C. Boesmueller, Benno Cardini, Michael Grimm, Julia Dumfarth, Dietmar Oefner, Thomas Resch |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
lcsh:Immunologic diseases. Allergy medicine.medical_specialty Immunology Anti-Inflammatory Agents Ischemia Urology Transplants Review Expanded Criteria Donor immunomodulation Organ transplantation immunogenecity 03 medical and health sciences marginal 0302 clinical medicine Transduction Genetic medicine Humans Immunology and Allergy Machine perfusion business.industry Stem Cells machine perfusion Organ Preservation Organ Transplantation medicine.disease Tissue Donors Perfusion Transplantation 030104 developmental biology Reperfusion Injury graft expanded criteria donor reconditioning business lcsh:RC581-607 Reperfusion injury Ex vivo 030215 immunology transplantation |
Zdroj: | Frontiers in Immunology, Vol 11 (2020) Frontiers in Immunology |
ISSN: | 1664-3224 |
DOI: | 10.3389/fimmu.2020.00631 |
Popis: | Organ transplantation is undergoing profound changes. Contraindications for donation have been revised in order to better meet the organ demand. The use of lower-quality organs and organs with greater preoperative damage, including those from donation after cardiac death (DCD), has become an established routine but increases the risk of graft malfunction. This risk is further aggravated by ischemia and reperfusion injury (IRI) in the process of transplantation. These circumstances demand a preservation technology that ameliorates IRI and allows for assessment of viability and function prior to transplantation. Oxygenated hypothermic and normothermic machine perfusion (MP) have emerged as valid novel modalities for advanced organ preservation and conditioning. Ex vivo prolonged lung preservation has resulted in successful transplantation of high-risk donor lungs. Normothermic MP of hearts and livers has displayed safe (heart) and superior (liver) preservation in randomized controlled trials (RCT). Normothermic kidney preservation for 24 h was recently established. Early clinical outcomes beyond the market entry trials indicate bioenergetics reconditioning, improved preservation of structures subject to IRI, and significant prolongation of the preservation time. The monitoring of perfusion parameters, the biochemical investigation of preservation fluids, and the assessment of tissue viability and bioenergetics function now offer a comprehensive assessment of organ quality and function ex situ. Gene and protein expression profiling, investigation of passenger leukocytes, and advanced imaging may further enhance the understanding of the condition of an organ during MP. In addition, MP offers a platform for organ reconditioning and regeneration and hence catalyzes the clinical realization of tissue engineering. Organ modification may include immunological modification and the generation of chimeric organs. While these ideas are not conceptually new, MP now offers a platform for clinical realization. Defatting of steatotic livers, modulation of inflammation during preservation in lungs, vasodilatation of livers, and hepatitis C elimination have been successfully demonstrated in experimental and clinical trials. Targeted treatment of lesions and surgical treatment or graft modification have been attempted. In this review, we address the current state of MP and advanced organ monitoring and speculate about logical future steps and how this evolution of a novel technology can result in a medial revolution. |
Databáze: | OpenAIRE |
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