Changing liver utilization and discard rates in clinical transplantation in the ex-vivo machine preservation era
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TLDR
A review of the history of ex-vivo liver machine preservation can be found in this paper , where the authors provide a brief overview of the major drivers of organ discard (age, ischemia time, steatosis etc.) and how this technology may ultimately revert such a trend.Abstract:
Liver transplantation is a well-established treatment for many with end-stage liver disease. Unfortunately, the increasing organ demand has surpassed the donor supply, and approximately 30% of patients die while waiting for a suitable liver. Clinicians are often forced to consider livers of inferior quality to increase organ donation rates, but ultimately, many of those organs end up being discarded. Extensive testing in experimental animals and humans has shown that ex-vivo machine preservation allows for a more objective characterization of the graft outside the body, with particular benefit for suboptimal organs. This review focuses on the history of the implementation of ex-vivo liver machine preservation and how its enactment may modify our current concept of organ acceptability. We provide a brief overview of the major drivers of organ discard (age, ischemia time, steatosis, etc.) and how this technology may ultimately revert such a trend. We also discuss future directions for this technology, including the identification of new markers of injury and repair and the opportunity for other ex-vivo regenerative therapies. Finally, we discuss the value of this technology, considering current and future donor characteristics in the North American population that may result in a significant organ discard.read more
References
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Journal ArticleDOI
Characteristics associated with liver graft failure: the concept of a donor risk index.
Sandy Feng,Nathan P. Goodrich,Jennifer L. Bragg-Gresham,Dawn M. Dykstra,J. D. Punch,M. A. DebRoy,S. M. Greenstein,Robert M. Merion +7 more
TL;DR: A quantitative donor risk index was developed using national data from 1998 to 2002 to assess the risk of donor liver graft failure using seven donor characteristics that independently predicted significantly increased risk of graft failure.
Journal ArticleDOI
Principles of solid-organ preservation by cold storage.
TL;DR: Presentation d'une nouvelle solution de conservation convenant aussi bien pour le refroidissement de l'sorgane in situ dans l'organisme du donneur que pour the conservation in vitro sous hypothermie.
Journal ArticleDOI
A randomized trial of normothermic preservation in liver transplantation
D Nasralla,Constantin C. Coussios,Hynek Mergental,M. Zeeshan Akhtar,Andrew J. Butler,Carlo D L Ceresa,Virginia Chiocchia,Susan J Dutton,Juan Carlos García-Valdecasas,Nigel Heaton,Charles Imber,Wayel Jassem,Ina Jochmans,John Karani,Simon R. Knight,Simon R. Knight,Peri Kocabayoglu,Massimo Malagó,Darius F. Mirza,Peter J. Morris,Peter J. Morris,Arvind Pallan,Andreas Paul,Mihai Pavel,M. Thamara P. R. Perera,Jacques Pirenne,R. Ravikumar,Leslie James Russell,Sara Upponi,Christopher J.E. Watson,Annemarie Weissenbacher,Rutger J. Ploeg,Peter J. Friend +32 more
TL;DR: Normothermic machine perfusion of the liver improved early graft function, demonstrated by reduced peak serum aspartate transaminase levels and early allograft dysfunction rates, and improved organ utilization and preservation times, although no differences were seen in graft or patient survival.
Journal ArticleDOI
Ischaemia-reperfusion injury in liver transplantation--from bench to bedside.
TL;DR: The latest mechanistic insights into innate–adaptive immune crosstalk and cell activation cascades that lead to inflammation-mediated injury in livers stressed by ischaemia–reperfusion are highlighted, progress in large animal experiments is discussed and efforts to minimize liver IRI in patients who have received a liver transplant are examined.
Journal ArticleDOI
Hypothermic Machine Preservation in Human Liver Transplantation: The First Clinical Series
James V. Guarrera,Scot D. Henry,Benjamin Samstein,R. Odeh‐Ramadan,M. Kinkhabwala,Michael J. Goldstein,Lloyd E. Ratner,John F. Renz,H. T. Lee,Robert S. Brown,Jean C. Emond +10 more
TL;DR: HMP of donor livers provided safe and reliable preservation in this pilot case‐controlled series and further multicenter HMP trials are now warranted.