Long-term normothermic machine preservation of human livers: what is needed to succeed?
Autor: | Vincent E de Meijer, Robert J. Porte, Bianca Lascaris, Adam M Thorne, Maarten W. N. Nijsten, Ton Lisman |
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Rok vydání: | 2022 |
Předmět: |
ORGAN PRESERVATION
Resuscitation Time Factors Physiology medicine.medical_treatment Organ Preservation Solutions PERFUSION SYSTEM Liver transplantation PRIMARY NONFUNCTION Artificial kidney liver preservation EXTRACORPOREAL MEMBRANE-OXYGENATION liver physiology Physiology (medical) FUNCTIONAL ASSESSMENT Homeostasis Humans Medicine Liver preservation Machine perfusion isolated liver perfusion liver transplantation CARDIOPULMONARY BYPASS KIDNEY PERFUSION BLOOD-FLOW Hepatology TRANSPLANTATION business.industry Regeneration (biology) machine perfusion Gastroenterology Diaphragm (structural system) Perfusion Liver Anesthesia COMPLEMENT ACTIVATION business |
Zdroj: | American Journal of Physiology-Gastrointestinal and Liver Physiology. 322:G183-G200 |
ISSN: | 1522-1547 0193-1857 |
Popis: | Although short‐term machine perfusion (≤24 h) allows for resuscitation and viability assessment of high‐risk donor livers, the donor organ shortage might be further remedied by long‐term perfusion machines. Extended preservation of injured donor livers may allow reconditioning, repairing, and regeneration. This review summarizes the necessary requirements and challenges for long‐term liver machine preservation, which requires integrating multiple core physiological functions to mimic the physiological environment inside the body. A pump simulates the heart in the perfusion system, including automatically controlled adjustment of flow and pressure settings. Oxygenation and ventilation are required to account for the absence of the lungs combined with continuous blood gas analysis. To avoid pressure necrosis and achieve heterogenic tissue perfusion during preservation, diaphragm movement should be simulated. An artificial kidney is required to remove waste products and control the perfusion solution’s composition. The perfusate requires an oxygen carrier, but will also be challenged by coagulation and activation of the immune system. The role of the pancreas can be mimicked through closed‐loop control of glucose concentrations by automatic injection of insulin or glucagon. Nutrients and bile salts, generally transported from the intestine to the liver, have to be supplemented when preserving livers long term. Especially for long‐term perfusion, the container should allow maintenance of sterility. In summary, the main challenge to develop a long‐term perfusion machine is to maintain the liver’s homeostasis in a sterile, carefully controlled environment. Long‐term machine preservation of human livers may allow organ regeneration and repair, thereby ultimately solving the shortage of donor livers. |
Databáze: | OpenAIRE |
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