☆ 4.8 Review

Obstacles to implement machine perfusion technology in routine clinical practice of transplantation: Why are we not there yet?

HEPATOLOGY (2023)

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Article Gastroenterology & Hepatology

Utilization of livers donated after circulatory death for transplantation-An international comparison

Janina Eden et al.

Summary: Liver graft utilization rates and discard rates vary across countries, with machine perfusion strategies contributing to better DCD utilization rates. Risk factors and use of various machine perfusion techniques vary between countries, but this does not significantly impact 5-year graft survival rates. Overall, countries with routine use of machine perfusion strategies have higher DCD utilization rates without compromised outcomes.

JOURNAL OF HEPATOLOGY (2023)

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Article Gastroenterology & Hepatology

A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation

Andrea Schlegel et al.

Summary: Hypothermic oxygenated perfusion (HOPE) after cold storage of donated livers reduces the incidence of complications and graft failure in liver transplantation.

JOURNAL OF HEPATOLOGY (2023)

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Article Surgery

Sequential hypothermic and normothermic perfusion preservation and transplantation of expanded criteria donor livers

Qiang Liu et al.

Summary: The purpose of this study was to assess the safety and feasibility of sequential hypothermic oxygenated perfusion and normothermic machine perfusion and the potential benefits of graft viability preservation and assessment before liver transplantation. 17 expanded criteria donor livers underwent sequential hypothermic oxygenated perfusion and normothermic machine perfusion. The results showed that sequential hypothermic oxygenated perfusion and normothermic machine perfusion preservation is safe and feasible and has the potential benefits of preserving and evaluating expanded criteria donor livers.

SURGERY (2023)

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Review Engineering, Biomedical

The economic impact of machine perfusion technology in liver transplantation

Yuri L. Boteon et al.

Summary: Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, but its economic outcomes are still underexplored. The upfront cost of machine perfusion may vary between modalities, but its use is likely to be cost-effective. Optimization of donor liver utilization rate, decreased complications, changes in logistics, and shorter hospital stays are potential cost savings points highlighted in the limited literature available.

ARTIFICIAL ORGANS (2022)

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Review Transplantation

Liver perfusion strategies: what is best and do ischemia times still matter?

Rebecca Panconesi et al.

Summary: Dynamic preservation techniques are being increasingly tested to improve donor utilization, with potential impact on posttransplant outcomes. More evidence from randomized controlled trials is needed for a comprehensive assessment of these new preservation technologies.

CURRENT OPINION IN ORGAN TRANSPLANTATION (2022)

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Article Gastroenterology & Hepatology

A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Andrea Schlegel et al.

Summary: The study established the best possible outcomes and reference values for liver transplantation using grafts donated after circulatory death (DCD) through benchmarking. The benchmark cases showed excellent 1-year retransplant and mortality rates, but had high rates of major complications. The use of organ perfusion technology reduced complications and improved outcomes in high-risk patients.

JOURNAL OF HEPATOLOGY (2022)

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Article Surgery

Impact of Portable Normothermic Blood-Based Machine Perfusion on Outcomes of Liver Transplant The OCS Liver PROTECT Randomized Clinical Trial

James F. Markmann et al.

Summary: This multicenter randomized clinical trial demonstrates that normothermic machine perfusion preservation of deceased donor livers reduces both early allograft dysfunction and ischemic biliary complications in liver transplant recipients, and increases the utilization of livers from donors after cardiac death.

JAMA SURGERY (2022)

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Review Cell Biology

Shaping of Hepatic Ischemia/Reperfusion Events: The Crucial Role of Mitochondria

Joao S. Teodoro et al.

Summary: Hepatic ischemia reperfusion injury (HIRI) is a major challenge in clinical scenarios such as liver resection and transplantation. This study highlights the strong correlation between HIRI induced by liver transplantation and early allograft dysfunction, and emphasizes the pivotal role of mitochondrial dysfunction in HIRI. Various strategies have been developed to protect and restore mitochondrial function, aiming to alleviate the adverse effects of HIRI.

CELLS (2022)

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Article Surgery

Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers

Otto B. van Leeuwen et al.

Summary: 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.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Surgery

Liver Transplantation Outcomes From Controlled Circulatory Death Donors SCS vs in situ NRP vs ex situ NMP

Rohit Gaurav et al.

Summary: NRP and NMP were associated with better early liver function compared to SCS, whereas NRP was associated with superior preservation of the biliary system.

ANNALS OF SURGERY (2022)

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Article Engineering, Biomedical

Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report

Stefano Baroni et al.

Summary: This paper describes a case series of DCD donors of liver and kidneys, investigating the changes in inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion. It was observed that hemadsorption led to a reduction in IL-10 and TNF-alpha levels, and successful transplantation of all organs was achieved without significant complications.

INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS (2022)

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Review Gastroenterology & Hepatology

Protective mechanisms and current clinical evidence of hypothermic oxygenated machine perfusion (HOPE) in preventing post-transplant cholangiopathy

Andrea Schlegel et al.

Summary: The development of cholangiopathies after liver transplantation impacts on the quality and duration of graft and patient survival. The clinical implementation of dynamic preservation strategies, such as hypothermic oxygenated perfusion (HOPE), has shown promising results in reducing biliary complications.

JOURNAL OF HEPATOLOGY (2022)

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Article Surgery

Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases

Roberto Hernandez-Alejandro et al.

Summary: The findings of this study suggest that selective hepatectomy and living-donor liver transplant may benefit patients with unresectable, liver-confined CRLMs, leading to favorable recurrence-free and overall survival rates.

JAMA SURGERY (2022)

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Article Surgery

Current practice of normothermic regional perfusion and machine perfusion in donation after circulatory death liver transplants in Italy

Riccardo De Carlis et al.

Summary: This survey shows that NRP with subsequent MP is the most commonly used protocol for DCD livers in Italy, although there is heterogeneity in the type and purpose of MP between centers.

UPDATES IN SURGERY (2022)

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Article Surgery

Hypothermic oxygenated perfusion in extended criteria donor liver transplantation-A randomized clinical trial

Matteo Ravaioli et al.

Summary: Hypothermic Oxygenated Perfusion (HOPE) of the liver can reduce the incidence of early allograft dysfunction (EAD) and failure in extended criteria donors (ECD) grafts. Compared to the traditional static cold storage (SCS) method, HOPE is associated with better graft survival.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Article Gastroenterology & Hepatology

In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death

Kayvan Mohkam et al.

Summary: In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) have similar outcomes in liver transplantation and appear to match the expected benchmarks for donation after brain death livers. This study may provide insights for further trial design.

LIVER TRANSPLANTATION (2022)

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Editorial Material Gastroenterology & Hepatology

In quest of the what, when, and where for machine perfusion dynamic liver preservation: Carpe diem!

Garrett R. Roll et al.

LIVER TRANSPLANTATION (2022)

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Letter Biotechnology & Applied Microbiology

Long-term preservation of liver grafts brings 'off-the-shelf' organs closer

Paulo N. Martins et al.

NATURE BIOTECHNOLOGY (2022)

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Review Surgery

Biliary Viability Assessment and Treatment Options of Biliary Injury During Normothermic Liver Perfusion-A Systematic Review

Jule Dingfelder et al.

Summary: Significant progress has been made in the field of liver machine perfusion in recent years, and many large transplant centers have incorporated machine perfusion strategies into their clinical routine. However, there is limited research on the effects of normothermic machine perfusion on biliary injury, and further investigation is needed to evaluate criteria for assessing damage to the biliary tree and the impact on the biliary system.

TRANSPLANT INTERNATIONAL (2022)

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Letter Surgery

Cost-utility analysis of normothermic and hypothermic ex-situ machine perfusion in liver transplantation

Julia Zimmermann et al.

BRITISH JOURNAL OF SURGERY (2022)

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Article Surgery

Hypothermic, oxygenated perfusion (HOPE) provides cardioprotection via succinate oxidation prior to normothermic perfusion in a rat model of donation after circulatory death (DCD)

Rahel K. Wyss et al.

Summary: The study investigated a new method for heart transplants used in DCD, called HOPE, which provides improved cardioprotection by reducing cardiac succinate levels, alleviating graft injury.

AMERICAN JOURNAL OF TRANSPLANTATION (2021)

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Editorial Material Gastroenterology & Hepatology

A Call for Randomization in Clinical Trials of Liver Machine Perfusion Preservation

Paulo N. Martins et al.

HEPATOLOGY (2021)

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Article Gastroenterology & Hepatology

Hypothermic Oxygenated Perfusion Improves Extended Criteria Donor Liver Graft Function and Reduces Duration of Hospitalization Without Extra Cost: The PERPHO Study

Michel Rayar et al.

Summary: The use of HOPE in liver transplantation can effectively lower AST and ALT levels, reduce ICU and hospital stay, without increasing the incidence of early allograft dysfunction or affecting graft and patient survival rates. The additional cost of HOPE per patient is estimated, but the overall cost and revenue balance does not significantly differ from the control group. These findings need further validation in a randomized trial.

LIVER TRANSPLANTATION (2021)

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Article Surgery

Successful pancreas allotransplantations after hypothermic machine perfusion in a novel diabetic porcine model: a controlled study

Thomas Prudhomme et al.

Summary: This experimental study compared static cold storage (SCS) to hypothermic machine perfusion (HMP) for pancreas preservation and found that HMP may reduce exocrine injury markers. In the allotransplantation experiment, there was no significant difference in recipient survival and function between HMP and SCS groups, regardless of the preservation duration.

TRANSPLANT INTERNATIONAL (2021)

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Editorial Material Medicine, General & Internal

Warming Up to Cold Perfusion

Winfred W. Williams et al.

Summary: Thousands of people in the United States die each year while awaiting lifesaving liver transplantation due to a lack of donor organs. This crisis has fueled interest in expanding the organ supply, including the use of organs from expanded-criteria donation.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Article Medicine, General & Internal

Hypothermic Machine Perfusion in Liver Transplantation - A Randomized Trial

R. Van Rijn et al.

Summary: This study demonstrated that hypothermic oxygenated machine perfusion can reduce the risk of nonanastomotic biliary strictures following liver transplantation from donors after circulatory death, with lower rates of complications compared to conventional static cold storage.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Review Biochemistry & Molecular Biology

Viability Assessment in Liver Transplantation-What Is the Impact of Dynamic Organ Preservation?

Rebecca Panconesi et al.

Summary: Assessment and prediction of liver function is crucial due to the increase of donor risk and majority of marginal organs. Traditional tests require prolonged diagnostic time and are difficult to assess, while dynamic organ preservation strategies offer an opportunity to evaluate organs before implantation through analysis of recirculating perfusates, bile, and perfused liver tissue.

BIOMEDICINES (2021)

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Article Immunology

Design, Analysis, and Pitfalls of Clinical Trials Using Ex Situ Liver Machine Perfusion: The International Liver Transplantation Society Consensus Guidelines

Paulo N. Martins et al.

Summary: In liver machine perfusion trials, proper trial design and data interpretation are crucial. Recommendations include publicly sharing protocols before trials, ensuring sufficient statistical power, and carefully considering randomization timing for primary outcomes.

TRANSPLANTATION (2021)

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Article Surgery

Hypothermic Oxygenated Machine Perfusion Reduces Early Allograft Injury and Improves Post-transplant Outcomes in Extended Criteria Donation Liver Transplantation From Donation After Brain Death Results From a Multicenter Randomized Controlled Trial (HOPE ECD-DBD)

Zoltan Czigany et al.

Summary: This study demonstrates that HOPE significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation compared to SCS.

ANNALS OF SURGERY (2021)

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Article Immunology

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

Andrea Schlegel et al.

Summary: Despite the increasing utilization of DCDs for LT, there is still controversy and no universal acceptance criteria for donor and recipient risk factors and prediction models. The International Liver Transplantation Society organized a consensus conference in Venice, Italy on January 31, 2020, to review current clinical practices worldwide and develop internationally accepted guidelines. Experts in the field were divided into 6 working groups to provide evidence-based recommendations, which were then reviewed and confirmed by a jury of conference attendees. Working group 2 presented final statements and recommendations covering donor and recipient risk factors and prediction models in DCD-LT.

TRANSPLANTATION (2021)

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Article Medicine, General & Internal

Disposal of donor livers in Brazil: how to optimize their utilization rate in transplants?

Julia Porto de Oliveira Drezza et al.

Summary: The study aimed to investigate professionals' perspectives on deceased donor liver transplantation, reasons for declining their use, and proposed strategies to increase usage safely. Results revealed a low acceptance rate of organs due to donor-related factors, suggesting the need for enhanced training for intensive care teams and investment in new technologies to optimize organ preservation and function before transplantation.

EINSTEIN-SAO PAULO (2021)

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Article Medicine, Research & Experimental

The Economic Burden of Postoperative Complications Predicted by the Comprehensive Complication Index® in Patients Undergoing Elective Major Hepatopancreaticobiliary Surgery for Malignancy - A Prospective Cost Analysis

Dimitri Aristotle Raptis et al.

Summary: This study found that postoperative complications significantly impact in-hospital costs of elective major HPB surgery for malignancy, with the CCI(R) and a novel cost prediction calculator showing good correlation with predicted costs.

IN VIVO (2021)

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Article Medicine, General & Internal

Impact of cardiopulmonary resuscitation on organ donation in Switzerland

Gottschalk Mirjam et al.

Summary: The study found that a substantial proportion of deceased organ donors in Switzerland underwent CPR during their hospitalization. CPR donors differed from non-CPR donors in terms of age, cause of death, and donation type. However, when carefully selected based on their hemodynamic condition, CPR donors were comparable to non-CPR donors in donor and organ utilization, as well as average organ yield.

SWISS MEDICAL WEEKLY (2021)

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Article Economics

The Actual Operative Costs of Liver Transplantation and Normothermic Machine Perfusion in a Canadian Setting

Alexandria N. Webb et al.

Summary: The study calculated the costs of liver procurement and transplantation, with the costs increasing to $35,659.22 and $48,076.18 when considering modifiers for in-province procurements. The minimum cost per NMP run was $18,593.02.

PHARMACOECONOMICS-OPEN (2021)

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Article Surgery

Brief O2 uploading during continuous hypothermic machine perfusion is simple yet effective oxygenation method to improve initial kidney function in a porcine autotransplant model

Tom Darius et al.

AMERICAN JOURNAL OF TRANSPLANTATION (2020)

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Article Biotechnology & Applied Microbiology

An integrated perfusion machine preserves injured human livers for 1 week

Dilmurodjon Eshmuminov et al.

NATURE BIOTECHNOLOGY (2020)

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Review Surgery

Hypothermic machine perfusion in liver transplantation

S. Karangwa et al.

INTERNATIONAL JOURNAL OF SURGERY (2020)

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Article Surgery

Viability testing of discarded livers with normothermic machine perfusion: Alleviating the organ shortage outweighs the cost

Siavash Raigani et al.

CLINICAL TRANSPLANTATION (2020)

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Hypothermic oxygenated perfusion protects from mitochondrial injury before liver transplantation

Andrea Schlegel et al.

EBIOMEDICINE (2020)

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Article Gastroenterology & Hepatology

Double-blind placebo-controlled randomized trial of N-acetylcysteine infusion following live donor liver transplantation

Mohammed Abdullatheef Thirunavayakalathil et al.

HEPATOLOGY INTERNATIONAL (2020)

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Building an innovation system of medical devices in China: Drivers, barriers, and strategies for sustainability

Sok Teng Cheong et al.

SAGE OPEN MEDICINE (2020)

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Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model

N. McMeekin et al.

BMC HEALTH SERVICES RESEARCH (2019)

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Christoph Tschuor et al.

JOURNAL OF HEPATOLOGY (2019)

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Article Surgery

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R. D. Staiger et al.

BRITISH JOURNAL OF SURGERY (2019)

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Editorial Material Gastroenterology & Hepatology

Evolving Trends in Machine Perfusion for Liver Transplantation

Phillipp Dutkowski et al.

GASTROENTEROLOGY (2019)

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Article Gastroenterology & Hepatology

Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation

Amelia J. Hessheimer et al.

JOURNAL OF HEPATOLOGY (2019)

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Article Gastroenterology & Hepatology

Outcomes of DCD liver transplantation using organs treated by hypothermic oxygenated perfusion before implantation

Andrea Schlegel et al.

JOURNAL OF HEPATOLOGY (2019)

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Article Endocrinology & Metabolism

Succinate accumulation drives ischaemia-reperfusion injury during organ transplantation

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NATURE METABOLISM (2019)

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Implementing an innovated preservation technology: The American Society of Transplant Surgeons' (ASTS) Standards Committee White Paper on Ex Situ Liver Machine Perfusion

Cristiano Quintini et al.

AMERICAN JOURNAL OF TRANSPLANTATION (2018)

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Review Transplantation

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Danielle Detelich et al.

CURRENT OPINION IN ORGAN TRANSPLANTATION (2018)

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Editorial Material Health Care Sciences & Services

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HEALTH AFFAIRS (2018)

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Article Gastroenterology & Hepatology

Hypothermic oxygenated machine perfusion reduces bile duct reperfusion injury after transplantation of donation after circulatory death livers

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LIVER TRANSPLANTATION (2018)

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Article Immunology

Utilization of Declined Liver Grafts Yields Comparable Transplant Outcomes and Previous Decline Should Not Be a Deterrent to Graft Use

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TRANSPLANTATION (2018)

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Article Gastroenterology & Hepatology

Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

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LIVER TRANSPLANTATION (2018)

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ANNALS OF SURGERY (2018)

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Cost-effectiveness analysis of two treatment strategies for chronic hepatitis C before and after access to direct-acting antivirals in Spain

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Haemoadsorption reduces the inflammatory response and improves blood flow during ex vivo renal perfusion in an experimental model

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JOURNAL OF TRANSLATIONAL MEDICINE (2017)

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Article Immunology

A Rodent Model of Cardiac Donation After Circulatory Death and Novel Biomarkers of Cardiac Viability During Ex Vivo Heart Perfusion

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TRANSPLANTATION (2017)

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GLOBAL HEART (2017)

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ASAIO JOURNAL (2017)

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Amelia J. Hessheimer et al.

CURRENT OPINION IN ORGAN TRANSPLANTATION (2017)

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Elmi Muller

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Article Gastroenterology & Hepatology

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LIVER TRANSPLANTATION (2016)

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Article Immunology

Oxygenated Hypothermic Machine Perfusion After Static Cold Storage Improves Hepatobiliary Function of Extended Criteria Donor Livers

Andrie C. Westerkamp et al.

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Jonathan P. Jarow et al.

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS (2015)

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Hypothermic Machine Preservation Facilitates Successful Transplantation of Orphan Extended Criteria Donor Livers

J. V. Guarrera et al.

AMERICAN JOURNAL OF TRANSPLANTATION (2015)

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Article Gastroenterology & Hepatology

Warm vs. cold perfusion techniques to rescue rodent liver grafts

Andrea Schlegel et al.

JOURNAL OF HEPATOLOGY (2014)

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Article Gastroenterology & Hepatology

HOPE for human liver grafts obtained from donors after cardiac death

Philipp Dutkowski et al.

JOURNAL OF HEPATOLOGY (2014)

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Ischaemic accumulation of succinate controls reperfusion injury through mitochondrial ROS

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Jacob Bergsland et al.

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Hypothermic Machine Preservation Attenuates Ischemia/Reperfusion Markers After Liver Transplantation: Preliminary Results

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Hypothermic Machine Perfusion Ameliorates Ischemia-Reperfusion Injury in Rat Lungs From Non-Heart-Beating Donors

Daisuke Nakajima et al.

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Hypothermic Machine Preservation in Human Liver Transplantation: The First Clinical Series

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Validation of a Current Definition of Early Allograft Dysfunction in Liver Transplant Recipients and Analysis of Risk Factors

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