Pretransplant sequential hypo- and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin-based oxygen carrier perfusion solution

Autor: Masato Fujiyoshi, Yvonne de Vries, Robert J. Porte, Ruben H J de Kleine, Otto B. van Leeuwen, Alix P M Matton, Maarten W. N. Nijsten, Vincent E de Meijer, Marieke T. de Boer, Maureen J M Werner, Peter Meyer, Marius C. van den Heuvel, Aad P. van den Berg, Carlijn I. Buis
Přispěvatelé: Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Microbes in Health and Disease (MHD), Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Resuscitation
donors and donation
medicine.medical_treatment
donors and donation: extended criteria
030230 surgery
Liver transplantation
Hemoglobins
0302 clinical medicine
Immunology and Allergy
Pharmacology (medical)
Warm Ischemia
dysfunction
liver transplantation
organ perfusion and preservation
Cold Ischemia
Shock
Middle Aged
practice
Perfusion
Solutions
ischemia reperfusion injury (IRI)
Brief Communications
Adult
medicine.medical_specialty
liver allograft function/dysfunction
liver allograft function
Urology
Cold storage
organ procurement and allocation
DONOR LIVERS
Brief Communication
clinical research/practice
03 medical and health sciences
COLD-STORAGE
Internal medicine
medicine
INJURY
Humans
PRESERVATION
organ procurement
Machine perfusion
business.industry
TRANSPLANTATION
Hepatology
Transplantation
Oxygen
clinical research
hepatology
extended criteria
Hemoglobin
business
liver transplantation/hepatology
Zdroj: American Journal of Transplantation
American Journal of Transplantation, 19(4), 1202-1211. Wiley
ISSN: 1600-6135
Popis: Ex situ dual hypothermic oxygenated machine perfusion (DHOPE) and normothermic machine perfusion (NMP) of donor livers may have a complementary effect when applied sequentially. While DHOPE resuscitates the mitochondria and increases hepatic adenosine triphosphate (ATP) content, NMP enables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE, NMP requires a perfusion solution with an oxygen carrier, for which red blood cells (RBC) have been used in most series. RBC, however, have limitations and cannot be used cold. We, therefore, established a protocol of sequential DHOPE, controlled oxygenated rewarming (COR), and NMP using a new hemoglobin‐based oxygen carrier (HBOC)‐based perfusion fluid (DHOPE‐COR‐NMP trial, NTR5972). Seven livers from donation after circulatory death (DCD) donors, which were initially declined for transplantation nationwide, underwent DHOPE‐COR‐NMP. Livers were considered transplantable if perfusate pH and lactate normalized, bile production was ≥10 mL and biliary pH > 7.45 within 150 minutes of NMP. Based on these criteria five livers were transplanted. The primary endpoint, 3‐month graft survival, was a 100%. In conclusion, sequential DHOPE‐COR‐NMP using an HBOC‐based perfusion fluid offers a novel method of liver machine perfusion for combined resuscitation and viability testing of suboptimal livers prior to transplantation.
This clinical cohort study indicates that a combination of hypo‐ and normothermic machine perfusion, using a preservation fluid containing an hemoglobin‐based oxygen carrier, is feasible and provides a tool to resuscitate and select initially declined high‐risk donor livers that can be transplanted successfully.
Databáze: OpenAIRE
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