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Normothermic ex-vivo liver perfusion: where do we stand?

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Title: Normothermic ex-vivo liver perfusion: where do we stand?
Authors: Jayant, K
Reccia, I
Shapiro, AMJ
Item Type: Journal Article
Abstract: INTRODUCTION: Nowadays liver transplantation is considered as the treatment of choice for patients presenting with the end-stage liver disease. However, the scarcity of suitable donor organs limits the delivery of care in a timely manner leading to the deaths of patients while on the waiting list. Recently, the concept of ex-situ normothermic machine perfusion (NMP) has emerged as an alternative to the standard organ preservation technique, static cold storage (SCS) and promises to not only restore the normal metabolic activity but attempts to recondition the marginal livers back to the pristine state which are otherwise more susceptible to ischemic injury and foster poor post-transplant outcomes. Areas Covered: An extensive search of all the published literature describing the role of NMP based device in liver transplantation as an alternative to SCS was made on MEDLINE, EMBASE, Cochrane, BIOSIS, Crossref, Scopus databases and clinical trial registry on 10 May 2018. Expert commentary: The main tenet of NMP is the establishment of the physiological milieu by providing physiological temperature, delivering oxygen, and nutrition, which permits aerobic metabolism to continue through the period of preservation and limits the effects of ischemia-reperfusion (I/R) injury. In addition, by assessing various metabolic and synthetic parameters the viability and suitability of donor livers for transplantation can be assessed. This important technological advancement has scored satisfactorily on the safety and efficacy parameters in preliminary clinical studies. The present review suggests that NMP can offer the opportunity to assess and safely utilize the marginal donor livers if deemed appropriate for the transplantation. However, the outcome of ongoing trials will determine the further adoption of this novel advent.
Issue Date: 20-Aug-2018
Date of Acceptance: 24-Jul-2018
URI: http://hdl.handle.net/10044/1/62899
DOI: https://dx.doi.org/10.1080/17474124.2018.1505499
ISSN: 1747-4124
Publisher: Taylor & Francis
Start Page: 1045
End Page: 1058
Journal / Book Title: Expert Review of Gastroenterology and Hepatology
Volume: 12
Issue: 10
Copyright Statement: © 2018 Informa UK Limited, trading as Taylor & Francis Group. This is an Accepted Manuscript of an article published by Taylor & Francis in on 20 Aug 2018, available online: https://www.tandfonline.com/doi/full/10.1080/17474124.2018.1505499
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Normothermic perfusion
liver transplantation
miRNA
extracellular vesicles
liver
postreperfusion syndrome
CELL-DERIVED MICROVESICLES
BILE-DUCT INJURY
EARLY ALLOGRAFT DYSFUNCTION
HUMAN DONOR LIVERS
MACHINE PERFUSION
CARDIAC DEATH
COLD-STORAGE
POSTREPERFUSION SYNDROME
ORGAN-PRESERVATION
PORCINE LIVERS
Normothermic perfusion
extracellular vesicles
liver
liver transplantation
miRNA
postreperfusion syndrome
Allografts
Donor Selection
Extracellular Vesicles
Humans
Liver
Liver Transplantation
Organ Preservation
Perfusion
Temperature
Time Factors
Gastroenterology & Hepatology
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-07-31
Appears in Collections:Division of Surgery
Faculty of Medicine



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