BACKGROUND: In times of critical organ shortage, poor organ pool utilization and increased use of extended-criteria donor (ECD) allografts remain a major problem. Hypothermic oxygenated machine perfusion (HOPE) has emerged as a promising and feasible strategy in ECD liver transplantation (LT). However, potential safety limits regarding the duration of perfusion are yet to be explored. Besides marginal allograft quality (steatosis), prolonged cold ischemia time remains the most important factor for a high number of liver allografts being declined for transplantation. PATIENTS AND METHODS: Two ECD-allografts were each allocated to two recipients, who proved to be unsuitable to receive the assigned allograft upon arrival at the transplant center. The organs were reallocated by Eurotransplant and accepted by our center for two different backup patients. During that time, HOPE was commenced and continued until the recipient hepatectomy was completed. Postoperative allograft function was assessed by serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and International Normalized Ratio. Incidence of early allograft dysfunction (EAD), postoperative complications, and length of hospital stay were analyzed. RESULTS: HOPE was applied for 4 h 35 min and 4 h 20 min, resulting in a total cold preservation time of 17 h 29 min and 15 h 20 min, respectively. Both recipients displayed decreasing serum transaminases and bilirubin levels postoperatively. No EAD or major postoperative complications occurred in either patient. Serum ALT and AST levels were within the normal range at discharge. CONCLUSIONS: Extended HOPE enables the safe extension of preservation time for up to 18 h in human LT. End-ischemic HOPE may significantly improve organ pool utilization, while simultaneously facilitating operating room logistics and preventing organ injury.
BACKGROUND: In times of critical organ shortage, poor organ pool utilization and increased use of extended-criteria donor (ECD) allografts remain a major problem. Hypothermic oxygenated machine perfusion (HOPE) has emerged as a promising and feasible strategy in ECD liver transplantation (LT). However, potential safety limits regarding the duration of perfusion are yet to be explored. Besides marginal allograft quality (steatosis), prolonged cold ischemia time remains the most important factor for a high number of liver allografts being declined for transplantation. PATIENTS AND METHODS: Two ECD-allografts were each allocated to two recipients, who proved to be unsuitable to receive the assigned allograft upon arrival at the transplant center. The organs were reallocated by Eurotransplant and accepted by our center for two different backup patients. During that time, HOPE was commenced and continued until the recipient hepatectomy was completed. Postoperative allograft function was assessed by serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and International Normalized Ratio. Incidence of early allograft dysfunction (EAD), postoperative complications, and length of hospital stay were analyzed. RESULTS: HOPE was applied for 4 h 35 min and 4 h 20 min, resulting in a total cold preservation time of 17 h 29 min and 15 h 20 min, respectively. Both recipients displayed decreasing serum transaminases and bilirubin levels postoperatively. No EAD or major postoperative complications occurred in either patient. Serum ALT and AST levels were within the normal range at discharge. CONCLUSIONS: Extended HOPE enables the safe extension of preservation time for up to 18 h in human LT. End-ischemic HOPE may significantly improve organ pool utilization, while simultaneously facilitating operating room logistics and preventing organ injury.
Authors: Isabel M A Brüggenwirth; Veerle A Lantinga; Michel Rayar; Aad P van den Berg; Hans Blokzijl; Koen M E M Reyntjens; Robert J Porte; Vincent E de Meijer Journal: BMJ Open Gastroenterol Date: 2022-01
Authors: Sandra Pavicevic; Sophie Reichelt; Deniz Uluk; Isabella Lurje; Cornelius Engelmann; Dominik P Modest; Uwe Pelzer; Felix Krenzien; Nathanael Raschzok; Christian Benzing; Igor M Sauer; Sebastian Stintzing; Frank Tacke; Wenzel Schöning; Moritz Schmelzle; Johann Pratschke; Georg Lurje Journal: Cancers (Basel) Date: 2022-02-17 Impact factor: 6.639
Authors: Isabel M A Brüggenwirth; Matteo Mueller; Veerle A Lantinga; Stefania Camagni; Riccardo De Carlis; Luciano De Carlis; Michele Colledan; Daniele Dondossola; Moritz Drefs; Janina Eden; Davide Ghinolfi; Dionysios Koliogiannis; Georg Lurje; Tommaso M Manzia; Diethard Monbaliu; Paolo Muiesan; Damiano Patrono; Johann Pratschke; Renato Romagnoli; Michel Rayar; Federico Roma; Andrea Schlegel; Philipp Dutkowski; Robert J Porte; Vincent E de Meijer Journal: Am J Transplant Date: 2022-04-05 Impact factor: 9.369
Authors: Lydia A Mercado; Harpreet K Bhangu; Esteban Calderon; Amit K Mathur; Bashar Aqel; Kaitlyn R Musto; Kymberly D Watt; Charles B Rosen; Candice Bolan; Jordan D LeGout; C Burcin Taner; Denise M Harnois; Kristopher P Croome Journal: Transplant Direct Date: 2022-10-07