Sequential Hypothermic and Normothermic Machine Perfusion of Extended Criteria Donors in Liver Transplantation: A Single-Center Preliminary Experience

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2025-02-19 DOI:10.1111/aor.14936

Paolo Magistri, Silvia Zamboni, Barbara Catellani, Cristiano Guidetti, Giuseppe Esposito, Daniela Caracciolo, Roberta Odorizzi, Giacomo Assirati, Tiziana Olivieri, Samuele Frassoni, Vincenzo Bagnardi, Gian Piero Guerrini, Stefano Di Sandro, Fabrizio Di Benedetto

{"title":"Sequential Hypothermic and Normothermic Machine Perfusion of Extended Criteria Donors in Liver Transplantation: A Single-Center Preliminary Experience","authors":"Paolo Magistri, Silvia Zamboni, Barbara Catellani, Cristiano Guidetti, Giuseppe Esposito, Daniela Caracciolo, Roberta Odorizzi, Giacomo Assirati, Tiziana Olivieri, Samuele Frassoni, Vincenzo Bagnardi, Gian Piero Guerrini, Stefano Di Sandro, Fabrizio Di Benedetto","doi":"10.1111/aor.14936","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Liver transplantation (LT) is the sole curative option for liver failure and other primary liver conditions. However, the limited number of suitable donors compared with the growing number of patients requiring LT remains a leading cause of mortality among those on the waiting list. This has resulted in the expansion of criteria for donor eligibility. The sequential combination of ex situ reperfusion, dHOPE, and NMP helps reduce the occurrence of ischemia–reperfusion injury and assess organ viability prior to transplantation.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This is a retrospective, single-arm, single-center study including all cases of liver grafts that underwent sequential perfusion between October 2021 and July 2024. Eligibility criteria for sequential perfusion were extended criteria DBD with macrosteatosis > 35%, use of high-dose vasopressors during donor ICU stay or episodes of cardiac arrest, hemodynamic instability during procurement, prolonged ischemia time for logistic reasons, as well as DCD showing prolonged fWIT, flow alteration during normothermic regional perfusion (NRP), and DCDs in Maastricht 2 class. Viability was assessed following the Groeningen group criteria.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Thirty-three cases were included and 16 met the viability criteria at the end of the sequential perfusion and were transplanted. One patient developed an early allograft failure (EAF) and another a primary nonfunction (PNF). All the other patients had a regular postoperative course, with no retransplantation, 56% of the cohort showing no postoperative complication and all currently in good standing, median follow-up 19 months (range 4–39).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Sequential dHOPE and NMP is a strategy that can help assessing both viability and functionality of liver grafts from high-risk donors, expanding the donor pool and increasing the opportunities for patients on the waiting list to get a transplant.</p>\n </section>\n </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":"49 4","pages":"705-715"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Artificial organs","FirstCategoryId":"5","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/aor.14936","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Liver transplantation (LT) is the sole curative option for liver failure and other primary liver conditions. However, the limited number of suitable donors compared with the growing number of patients requiring LT remains a leading cause of mortality among those on the waiting list. This has resulted in the expansion of criteria for donor eligibility. The sequential combination of ex situ reperfusion, dHOPE, and NMP helps reduce the occurrence of ischemia–reperfusion injury and assess organ viability prior to transplantation.

Methods

This is a retrospective, single-arm, single-center study including all cases of liver grafts that underwent sequential perfusion between October 2021 and July 2024. Eligibility criteria for sequential perfusion were extended criteria DBD with macrosteatosis > 35%, use of high-dose vasopressors during donor ICU stay or episodes of cardiac arrest, hemodynamic instability during procurement, prolonged ischemia time for logistic reasons, as well as DCD showing prolonged fWIT, flow alteration during normothermic regional perfusion (NRP), and DCDs in Maastricht 2 class. Viability was assessed following the Groeningen group criteria.

Results

Thirty-three cases were included and 16 met the viability criteria at the end of the sequential perfusion and were transplanted. One patient developed an early allograft failure (EAF) and another a primary nonfunction (PNF). All the other patients had a regular postoperative course, with no retransplantation, 56% of the cohort showing no postoperative complication and all currently in good standing, median follow-up 19 months (range 4–39).

Conclusions

Sequential dHOPE and NMP is a strategy that can help assessing both viability and functionality of liver grafts from high-risk donors, expanding the donor pool and increasing the opportunities for patients on the waiting list to get a transplant.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.