Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers
© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons..
Ex situ normothermic machine perfusion (NMP) is increasingly used for viability assessment of high-risk donor livers, whereas dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury. We aimed to resuscitate and test the viability of initially-discarded, high-risk donor livers using sequential DHOPE and NMP with two different oxygen carriers: an artificial hemoglobin-based oxygen carrier (HBOC) or red blood cells (RBC). In a prospective observational cohort study of 54 livers that underwent DHOPE-NMP, the first 18 procedures were performed with a HBOC-based perfusion solution and the subsequent 36 procedures were performed with an RBC-based perfusion solution for the NMP phase. All but one livers were derived from extended criteria donation after circulatory death donors, with a median donor risk index of 2.84 (IQR 2.52-3.11). After functional assessment during NMP, 34 livers (63% utilization), met the viability criteria and were transplanted. One-year graft and patient survival were 94% and 100%, respectively. Post-transplant cholangiopathy occurred in 1 patient (3%). There were no significant differences in utilization rate and post-transplant outcomes between the HBOC and RBC group. Ex situ machine perfusion using sequential DHOPE-NMP for resuscitation and viability assessment of high-risk donor livers results in excellent transplant outcomes, irrespective of the oxygen carrier used.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - 22(2022), 6 vom: 16. Juni, Seite 1658-1670 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van Leeuwen, Otto B [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.06.2022 Date Revised 24.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/ajt.17022 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM338175113 |
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| 245 | 1 | 0 | |a Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers |
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| 500 | |a Date Revised 24.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons. | ||
| 520 | |a Ex situ normothermic machine perfusion (NMP) is increasingly used for viability assessment of high-risk donor livers, whereas dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury. We aimed to resuscitate and test the viability of initially-discarded, high-risk donor livers using sequential DHOPE and NMP with two different oxygen carriers: an artificial hemoglobin-based oxygen carrier (HBOC) or red blood cells (RBC). In a prospective observational cohort study of 54 livers that underwent DHOPE-NMP, the first 18 procedures were performed with a HBOC-based perfusion solution and the subsequent 36 procedures were performed with an RBC-based perfusion solution for the NMP phase. All but one livers were derived from extended criteria donation after circulatory death donors, with a median donor risk index of 2.84 (IQR 2.52-3.11). After functional assessment during NMP, 34 livers (63% utilization), met the viability criteria and were transplanted. One-year graft and patient survival were 94% and 100%, respectively. Post-transplant cholangiopathy occurred in 1 patient (3%). There were no significant differences in utilization rate and post-transplant outcomes between the HBOC and RBC group. Ex situ machine perfusion using sequential DHOPE-NMP for resuscitation and viability assessment of high-risk donor livers results in excellent transplant outcomes, irrespective of the oxygen carrier used | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a clinical research / practice | |
| 650 | 4 | |a donation after circulatory death (DCD) | |
| 650 | 4 | |a donors and donation | |
| 650 | 4 | |a liver transplantation / hepatology | |
| 650 | 4 | |a organ perfusion and preservation | |
| 650 | 7 | |a Hemoglobins |2 NLM | |
| 650 | 7 | |a Oxygen |2 NLM | |
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| 700 | 1 | |a Bodewes, Silke B |e verfasserin |4 aut | |
| 700 | 1 | |a Lantinga, Veerle A |e verfasserin |4 aut | |
| 700 | 1 | |a Haring, Martijn P D |e verfasserin |4 aut | |
| 700 | 1 | |a Thorne, Adam M |e verfasserin |4 aut | |
| 700 | 1 | |a Brüggenwirth, Isabel M A |e verfasserin |4 aut | |
| 700 | 1 | |a van den Berg, Aad P |e verfasserin |4 aut | |
| 700 | 1 | |a de Boer, Marieke T |e verfasserin |4 aut | |
| 700 | 1 | |a de Jong, Iris E M |e verfasserin |4 aut | |
| 700 | 1 | |a de Kleine, Ruben H J |e verfasserin |4 aut | |
| 700 | 1 | |a Lascaris, Bianca |e verfasserin |4 aut | |
| 700 | 1 | |a Nijsten, Maarten W N |e verfasserin |4 aut | |
| 700 | 1 | |a Reyntjens, Koen M E M |e verfasserin |4 aut | |
| 700 | 1 | |a de Meijer, Vincent E |e verfasserin |4 aut | |
| 700 | 1 | |a Porte, Robert J |e verfasserin |4 aut | |
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