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Journal ArticleDOI

Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial.

TL;DR: A preliminary single‐center North American experience using identical NMP technology demonstrates feasibility as well as potential technical risks of NMP in a North American setting and highlights a need for larger, randomized studies.
About: This article is published in American Journal of Transplantation.The article was published on 2017-04-01. It has received 170 citations till now. The article focuses on the topics: Liver function & Liver transplantation.
Citations
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Journal ArticleDOI
TL;DR: Evaluation of bile pH may offer a valuable insight into bile duct integrity and risk of posttransplant ischemic cholangiopathy, as well as a combination of transaminase release, glucose metabolism, lactate clearance, and maintenance of acid‐base balance.

251 citations


Cites background from "Preliminary Single-Center Canadian ..."

  • ...Although there have been case reports and small series of liver transplants following ex situ normothermic perfusion (4-8), there are as yet no validated criteria predicting liver viability....

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Journal ArticleDOI
TL;DR: In this article, the authors showed that liver transplantation after circulatory death is associated with an increased risk of nonanastomotic biliary strictures and hypothermic oxygenated machine (HOMEM) was used to treat the strictures.
Abstract: Background Transplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine ...

219 citations

Journal ArticleDOI
TL;DR: 5-year graft survival in donation after cardiac death livers treated by conventional cold storage, or by 1-2 h of hypothermic oxygenated perfusion (HOPE) after cold storage suggests that a simple end-ischaemic perfusion approach is very effective and may open the field for safe utilisation of extended DCD liver grafts.

206 citations

Journal ArticleDOI
TL;DR: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation, which may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients.
Abstract: Objective:The aim of this study was to determine the predictive value of machine perfusate analysis on graft outcome.Background:Ex situ machine perfusion (MP) is gaining increasing interest to potentially repair injured organs and to assess organ function. In the field of liver transplantation, howe

137 citations


Cites result from "Preliminary Single-Center Canadian ..."

  • ...1B), when compared to previous published values from DCD livers during end-ischemic normothermic perfusion.(2,21) Second, the release of mitochondrial flavin, for example, FMN, occurred independently from the release of cytosolic hepatocellular enzymes, for example, AST, ALT, or LDH, consistent with a mitochondrial origin of FMN (Fig....

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References
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Journal ArticleDOI
TL;DR: The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.
Abstract: Growing demand for health care, rising costs, constrained resources, and evidence of variations in clinical practice have triggered interest in measuring and improving the quality of health care delivery. For a valuable quality assessment, relevant data on outcome must be obtained in a standardized and reproducible manner to allow comparison among different centers, between different therapies and within a center over time.1–3 Objective and reliable outcome data are increasingly requested by patients and payers (government or private insurance) to assess quality and costs of health care. Moreover, health policy makers point out that the availability of comparative data on individual hospital's and physician's performance represents a powerful market force, which may contribute to limit the costs of health care while improving quality.4 Conclusive assessments of surgical procedures remain limited by the lack of consensus on how to define complications and to stratify them by severity.1,5–8 In 1992, we proposed general principles to classify complications of surgery based on a therapy-oriented, 4-level severity grading.1 Subsequently, the severity grading was refined and applied to compare the results of laparoscopic versus open cholecystectomy9 and liver transplantation.10 This classification has also been used by others11–13 and was recently suggested to serve as the basis to assess the outcome of living related liver transplantation in the United States (J. Trotter, personal communication). However, the classification system has not yet been widely used in the surgical literature. The strength of the previous classification relied on the principle of grading complications based on the therapy used to treat the complication. This approach allows identification of most complications and prevents down-rating of major negative outcomes. This is particularly important in retrospective analyses. However, we felt that modifications were necessary, particularly in grading life-threatening complications and long-term disability due to a complication. We also felt that the duration of the hospital stay can no longer be used as a criterion to grade complications. Although definitions of negative outcomes rely to a large extend on subjective “value” appraisals, the grading system must be tested in a large cohort of patients. Finally, a classification is useful only if widely accepted and applied throughout different countries and surgical cultures. Such a validation was not done with the previous classification. Therefore, the aim of the current study was 3-fold: first, to propose an improved classification of surgical complications based on our experience gained with the previous classification1; second, to test this classification in a large cohort of patients who underwent general surgery; and third, to assess the reproducibility and acceptability of the classification through an international survey.

23,435 citations


"Preliminary Single-Center Canadian ..." refers background in this paper

  • ...7 days; (iii) EAD incidence in the first 7 days (24); (iv) liver biochemistry in serum on days 1–7, 10, and 30; (v) major complications defined by a ClavienDindo score ≥3 (25); (vi) patient and graft survival at 6 mo; and (vii) biliary...

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Journal ArticleDOI
TL;DR: A simple definition of EAD using objective posttransplant criteria identified a 23% incidence, and was highly associated with graft loss and patient mortality, validating previously published criteria.

816 citations


"Preliminary Single-Center Canadian ..." refers background in this paper

  • ...7 days; (iii) EAD incidence in the first 7 days (24); (iv) liver biochemistry in serum on days 1–7, 10, and 30; (v) major complications defined by a ClavienDindo score ≥3 (25); (vi) patient and graft survival at 6 mo; and (vii) biliary...

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Journal ArticleDOI
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.

480 citations

Journal ArticleDOI
TL;DR: This first report of liver transplantation using NMP‐preserved livers demonstrates the safety and feasibility of using this technology from retrieval to transplantation, including transportation, and may be valuable in increasing the number of donor livers and improving the function of transplantable organs.

373 citations


"Preliminary Single-Center Canadian ..." refers background or methods or result in this paper

  • ...) was completed in the United Kingdom, demonstrating feasibility and safety (23)....

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  • ...Furthermore, in contrast to Ravikumar et al and Selzner et al, we did not observe significant differences in early recipient transaminases between NMP and SCS preserved grafts (23,30)....

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  • ...Ravikumar et al showed that NMP livers had lower median peak aspartate aminotransferase (AST) levels compared with matched SCS controls, suggesting enhanced hepatic protection....

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  • ...Normothermic machine perfusion Livers allocated to the intervention group were preserved using the NMP system (Organ Ox metra), as described recently (Figure S2) (23)....

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  • ...All perfusate additives were otherwise identical to those described by Ravikumar et al (23)....

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Journal ArticleDOI
TL;DR: There was a lack of survival benefit in DCD livers utilized in patients with model for end‐stage liver disease (MELD) ≤30 or those not on organ‐perfusion support, as graft survival was significantly lower compared to DBD patients, however, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusions support had similar graft survival, suggesting a potentially greater benefit of DCDLivers in critically ill patients.

298 citations

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