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HOPE for human liver grafts obtained from donors after cardiac death


Dutkowski, Philipp; Schlegel, Andrea; de Oliveira, Michelle; Müllhaupt, Beat; Neff, Fabienne; Clavien, Pierre-Alain (2014). HOPE for human liver grafts obtained from donors after cardiac death. Journal of Hepatology, 60(4):765-772.

Abstract

BACKGROUND & AIMS: Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs.
METHODS: Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38min, followed by a standard cold flush and static storage at 4°C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10°C and oxygenated (pO2 60kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3mmHg.
RESULTS: Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5months.
CONCLUSIONS: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.

Abstract

BACKGROUND & AIMS: Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs.
METHODS: Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38min, followed by a standard cold flush and static storage at 4°C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10°C and oxygenated (pO2 60kPa) using an ECOPS device (Organ Assist®). Perfusion pressure was maintained below 3mmHg.
RESULTS: Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5months.
CONCLUSIONS: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Visceral and Transplantation Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Gastroenterology and Hepatology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:05 Feb 2014 14:42
Last Modified:05 Apr 2016 17:31
Publisher:Elsevier
ISSN:0168-8278
Publisher DOI:https://doi.org/10.1016/j.jhep.2013.11.023
PubMed ID:24295869

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