Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
01 05 2023
01 05 2023
Historique:
received:
23
05
2022
accepted:
08
09
2022
medline:
17
4
2023
pubmed:
20
9
2022
entrez:
19
9
2022
Statut:
ppublish
Résumé
End-ischemic viability testing by normothermic machine perfusion (NMP) represents an effective strategy to recover liver grafts having initially been discarded for liver transplantation (LT). However, its results in the setting of significant (≥30%) macrovesicular steatosis (MaS) have not been specifically assessed. Prospectively maintained databases at two high-volume LT centers in Northern Italy were searched to identify cases of end-ischemic NMP performed to test the viability of livers with MaS ≥ 30% in the period from January 2019 to January 2022. A total of 14 cases were retrieved, representing 57.9% of NMP and 5.7% of all machine perfusion procedures. Of those patients, 10 (71%) received transplants. Two patients developed primary nonfunction (PNF) and required urgent re-LT, and both were characterized by incomplete or suboptimal lactate clearance during NMP. PNF cases were also characterized by higher perfusate transaminases, lower hepatic artery and portal vein flows at 2 h, and a lack of glucose metabolism in one case. The remaining eight patients showed good liver function (Liver Graft Assessment Following Transplantation risk score, -1.9 [risk, 13.6%]; Early Allograft Failure Simplified Estimation score, -3.7 [risk, 2.6%]) and had a favorable postoperative course. Overall, NMP allowed successful transplantation of 57% of livers with moderate-to-severe MaS. Our findings suggest that prolonged observation (≥6 h) might be required for steatotic livers and that stable lactate clearance is a fundamental prerequisite for their use.
Identifiants
pubmed: 36117430
pii: 01445473-202305000-00007
doi: 10.1002/lt.26574
pmc: PMC10106107
doi:
Substances chimiques
Lactates
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
508-520Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Références
Attia M, Silva MA, Mirza DF. The marginal liver donor an update. Transpl Int. 2008;21:713–24.
Feng S, Goodrich NP, Bragg‐Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783–90.
Croome KP, Lee DD, Taner CB. The "Skinny" on assessment and utilization of steatotic liver grafts: a systematic review. Liver Transpl. 2019;25:488–99.
El‐Badry AM, Breitenstein S, Jochum W, Washington K, Paradis V, Rubbia‐Brandt L, et al. Assessment of hepatic steatosis by expert pathologists: the end of a gold standard. Ann Surg. 2009;250:691–7.
Briceno J, Padillo J, Rufian S, Solorzano G, Pera C. Assignment of steatotic livers by the Mayo model for end‐stage liver disease. Transpl Int. 2005;18:577–83.
Deroose JP, Kazemier G, Zondervan P, Ijzermans JN, Metselaar HJ, Alwayn IP. Hepatic steatosis is not always a contraindication for cadaveric liver transplantation. HPB (Oxford). 2011;13:417–25.
Spitzer AL, Lao OB, Dick AA, Bakthavatsalam R, Halldorson JB, Yeh MM, et al. The biopsied donor liver: incorporating macrosteatosis into high‐risk donor assessment. Liver Transpl. 2010;16:874–884.
Eslam M, Sanyal AJ, George J, International Consensus P. MAFLD: a consensus‐driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158:1999–2014 e1.
Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state‐level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440–50.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease‐Meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.
Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. Global prevalence, incidence, and outcomes of non‐obese or lean non‐alcoholic fatty liver disease: a systematic review and meta‐analysis. Lancet Gastroenterol Hepatol. 2020;5:739–52.
Yuan L, Hanlon CL, Terrault N, Alqahtani S, Tamim H, Lai M, et al. Portrait of regional trends in liver transplantation for nonalcoholic steatohepatitis in the United States. Am J Gastroenterol. 2022;117:433–444.
Czigany Z, Pratschke J, Fronek J, Guba M, Schoning W, Raptis DA, et al. Hypothermic Oxygenated Machine Perfusion (HOPE) Reduces Early Allograft Injury and Improves Post‐Transplant Outcomes in Extended Criteria Donation (ECD) Liver Transplantation from Donation After Brain Death (DBD): Results from a Multicenter Randomized Controlled Trial (HOPE ECD‐DBD). Ann Surg. 2021;274:705–12.
Nasralla D, Coussios CC, Mergental H, Akhtar MZ, Butler AJ, Ceresa CDL, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557:50–6.
Ravikumar R, Jassem W, Mergental H, Heaton N, Mirza D, Perera MT, et al. Liver transplantation after ex vivo normothermic machine preservation: a phase 1 (first‐in‐man) clinical trial. Am J Transplant. 2016;16:1779–87.
van Rijn R, Schurink IJ, de Vries Y, van den Berg AP, Cortes Cerisuelo M, Darwish Murad S, et al. Hypothermic machine perfusion in liver transplantation ‐ a randomized trial. N Engl J Med. 2021;384(15):1391–401.
Schlegel A, Muller X, Kalisvaart M, Muellhaupt B, Perera M, Isaac JR, et al. Outcomes of DCD liver transplantation using organs treated by hypothermic oxygenated perfusion before implantation. J Hepatol. 2018;122(6):1122–31.
Mergental H, Laing RW, Kirkham AJ, Perera M, Boteon YL, Attard J, et al. Transplantation of discarded livers following viability testing with normothermic machine perfusion. Nat Commun. 2020;11:2939.
Cardini B, Oberhuber R, Fodor M, Hautz T, Margreiter C, Resch T, et al. Clinical implementation of prolonged liver preservation and monitoring through normothermic machine perfusion in liver transplantation. Transplantation. 2020;104:1917–28.
Ceresa CDL, Nasralla D, Watson CJE, Butler AJ, Coussios CC, Crick K, et al. Transient cold storage prior to normothermic liver perfusion may facilitate adoption of a novel technology. Liver Transpl. 2019;25:1503–1513.
Fodor M, Cardini B, Peter W, Weissenbacher A, Oberhuber R, Hautz T, et al. Static cold storage compared with normothermic machine perfusion of the liver and effect on ischaemic‐type biliary lesions after transplantation: a propensity score‐matched study. Br J Surg. 2021;108:1082–9.
Watson CJE, Kosmoliaptsis V, Pley C, Randle L, Fear C, Crick K, et al. Observations on the ex situ perfusion of livers for transplantation. Am J Transplant. 2018;18:2005–2020.
Quintini C, Del Prete L, Simioni A, Del Angel L, Diago Uso T, D'Amico G, et al. Transplantation of declined livers after normothermic perfusion. Surgery. 2022;171:747–56.
Patrono D, Lonati C, Romagnoli R. Viability testing during liver preservation. Curr Opin Organ Transplant. 2022;27:454–65.
Patrono D, Catalano G, Rizza G, Lavorato N, Berchialla P, Gambella A, et al. Perfusate analysis during dual hypothermic oxygenated machine perfusion of liver grafts: correlations with donor factors and early outcomes. Transplantation. 2020;104:1929–42.
Patrono D, Cussa D, Sciannameo V, Montanari E, Panconesi R, Berchialla P, et al. Outcome of liver transplantation with grafts from brain‐dead donors treated with dual hypothermic oxygenated machine perfusion, with particular reference to elderly donors. Am J Transplant. 2022;22:1382–95.
Patrono D, Lavezzo B, Molinaro L, Rizza G, Catalano G, Gonella F, et al. Hypothermic oxygenated machine perfusion for liver transplantation: an initial experience. Exp Clin Transplant. 2018;16:172–6.
Patrono D, Roggio D, Mazzeo AT, Catalano G, Mazza E, Rizza G, et al. Clinical assessment of liver metabolism during hypothermic oxygenated machine perfusion using microdialysis. Artif Organs. 2022;46:281–95.
Patrono D, Surra A, Catalano G, Rizza G, Berchialla P, Martini S, et al. Hypothermic oxygenated machine perfusion of liver grafts from brain‐dead donors. Sci Rep. 2019;9:9337.
Patrono D, Cussa D, Rigo F, Romagnoli R, Liver Machine Perfusion Survey G. Heterogeneous indications and the need for viability assessment: an international survey on the use of machine perfusion in liver transplantation. Artif Organs. 2022;46:296–305.
Ghinolfi D, Rreka E, De Tata V, Franzini M, Pezzati D, Fierabracci V, et al. Pilot, open, randomized, prospective trial for normothermic machine perfusion evaluation in liver transplantation from older donors. Liver Transpl. 2019;25:436–449.
Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc. 1987;19(4 Suppl 3):54–55.
Hilmi I, Horton CN, Planinsic RM, Sakai T, Nicolau‐Raducu R, Damian D, et al. The impact of postreperfusion syndrome on short‐term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation. Liver Transpl. 2008;14:504–8.
Clavien PA, Harvey PR, Strasberg SM. Preservation and reperfusion injuries in liver allografts. An overview and synthesis of current studies. Transplantation. 1992;53:957–78.
Avolio AW, Franco A, Schlegel A, Lai Q, Meli S, Burra P, et al. Development and validation of a comprehensive model to estimate early allograft failure among patients requiring early liver retransplant. JAMA Surg. 2020;155:e204095.
Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16:943–99.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–84.
Agopian VG, Harlander‐Locke MP, Markovic D, Dumronggittigule W, Xia V, Kaldas FM, et al. Evaluation of early allograft function using the liver graft assessment following transplantation risk score model. JAMA Surg. 2018;153:436–444.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1–7.
De Carlis R, Di Sandro S, Lauterio A, Botta F, Ferla F, Andorno E, et al. Liver grafts from donors after circulatory death on regional perfusion with extended warm ischemia compared with donors after brain death. Liver Transpl. 2018;24:1523–35.
Patrono D, Zanierato M, Vergano M, Magaton C, Diale E, Rizza G, et al. Normothermic regional perfusion and hypothermic oxygenated machine perfusion for livers donated after controlled circulatory death with prolonged warm ischemia time: a matched comparison with livers from brain‐dead donors. Transpl Int. 2022;35:10390.
De Carlis R, Di Sandro S, Lauterio A, Ferla F, Dell'Acqua A, Zanierato M, et al. Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion. Liver Transpl. 2017;23:166–73.
De Carlis R, Schlegel A, Frassoni S, Olivieri T, Ravaioli M, Camagni S, et al. How to preserve liver grafts from circulatory death with long warm ischemia? A retrospective italian cohort study with normothermic regional perfusion and hypothermic oxygenated perfusion. Transplantation. 2021;105:2385–96.
Levitt DG, Levitt JE, Levitt MD. Quantitative assessment of blood lactate in shock: measure of hypoxia or beneficial energy source. Biomed Res Int. 2020;2020:2608318.
Watson CJE, Jochmans I. From “Gut Feeling” to objectivity: machine preservation of the liver as a tool to assess organ viability. Curr Transplant Rep. 2018;5:72–81.
de Vries Y, Matton APM, Nijsten MWN, Werner MJM, van den Berg AP, de Boer MT, et al. Pretransplant sequential hypo‐ and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin‐based oxygen carrier perfusion solution. Am J Transplant. 2019;19:1202–1211.
Mergental H, Perera MT, Laing RW, Muiesan P, Isaac JR, Smith A, et al. Transplantation of declined liver allografts following normothermic ex‐situ evaluation. Am J Transplant. 2016;16:3235–45.
van Leeuwen OB, Bodewes SB, Lantinga VA, Haring MPD, Thorne AM, Bruggenwirth IMA, et al. Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high‐risk donor livers. Am J Transplant. 2022;22:1658–70.
Hann A, Lembach H, Nutu A, Mergental H, Isaac JL, Isaac JR, et al. Assessment of deceased brain dead donor liver grafts via normothermic machine perfusion: lactate clearance time threshold can be safely extended to 6 hours. Liver Transpl. 2022;28:493–6.
Watson CJE, Gaurav R, Fear C, Swift L, Selves L, Ceresa CDL, et al. Predicting early allograft function after normothermic machine perfusion. Transplantation. 2022;106:2391–8.
Weissenbacher A, Bogensperger C, Oberhuber R, Meszaros A, Gasteiger S, Ulmer H, et al. Perfusate enzymes and platelets indicate early allograft dysfunction after transplantation of normothermically preserved livers. Transplantation. 2021.
Schlegel A. Machine perfusion as "comfort zone": what are key challenges of liver viability assessment today? Transplantation. 2022;106:2295–8.
Zhang Z, Tang Y, Zhao Q, Wang L, Zhu C, Ju W, et al. Association of perfusion characteristics and posttransplant liver function in ischemia‐free liver transplantation. Liver Transpl. 2020;26:1441–54.
Neil DAH, Minervini M, Smith ML, Hubscher SG, Brunt EM, Demetris AJ. Banff consensus recommendations for steatosis assessment in donor livers. Hepatology. 2022;75(4):1014–25.
Matton APM, de Vries Y, Burlage LC, van Rijn R, Fujiyoshi M, de Meijer VE, et al. Biliary bicarbonate, pH, and glucose are suitable biomarkers of biliary viability during ex situ normothermic machine perfusion of human donor livers. Transplantation. 2019;103:1405–1413.