Trends and Obstacles to Implement Dynamic Perfusion Concepts for Clinical Liver Transplantation: Results from a Global Web-Based Survey.
dynamic organ preservation
liver transplantation
organ perfusion
survey
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
30 May 2023
30 May 2023
Historique:
received:
30
03
2023
revised:
23
05
2023
accepted:
26
05
2023
medline:
10
6
2023
pubmed:
10
6
2023
entrez:
10
6
2023
Statut:
epublish
Résumé
Organ perfusion technology is increasingly used in many countries, with a focus, however, on the Western world. This study investigates the current international trends and obstacles to the broader routine implementation of dynamic perfusion concepts in liver transplantation. A web-based anonymous survey was launched in 2021. Experts of all involved specializations from 70 centers in 34 countries were contacted, based on the published literature and experience in the field of abdominal organ perfusion. Overall, 143 participants from 23 countries completed the survey. Most respondents were male (67.8%) and transplant surgeons (64.3%) working at university hospitals (67.9%). The majority had experience with organ perfusion (82%), applying mainly hypothermic machine perfusion (HMP; 38%) and other concepts. While most (94.4%) expect a higher utilization of marginal organs with machine perfusion, the majority considers HMP the best technique to reduce liver discard-rates. While most respondents (90%) believed machine perfusion should be fully commissioned, the lack of funding (34%) and knowledge (16%) as well as limited staff (19%) were the three main obstacles to a routine clinical implementation. Although dynamic preservation concepts are increasingly used in clinical practice, significant challenges remain. Specific financial pathways, uniform regulations, and tight collaborations among involved experts are needed to achieve wider global clinical use.
Sections du résumé
BACKGROUND
BACKGROUND
Organ perfusion technology is increasingly used in many countries, with a focus, however, on the Western world. This study investigates the current international trends and obstacles to the broader routine implementation of dynamic perfusion concepts in liver transplantation.
METHODS
METHODS
A web-based anonymous survey was launched in 2021. Experts of all involved specializations from 70 centers in 34 countries were contacted, based on the published literature and experience in the field of abdominal organ perfusion.
RESULTS
RESULTS
Overall, 143 participants from 23 countries completed the survey. Most respondents were male (67.8%) and transplant surgeons (64.3%) working at university hospitals (67.9%). The majority had experience with organ perfusion (82%), applying mainly hypothermic machine perfusion (HMP; 38%) and other concepts. While most (94.4%) expect a higher utilization of marginal organs with machine perfusion, the majority considers HMP the best technique to reduce liver discard-rates. While most respondents (90%) believed machine perfusion should be fully commissioned, the lack of funding (34%) and knowledge (16%) as well as limited staff (19%) were the three main obstacles to a routine clinical implementation.
CONCLUSION
CONCLUSIONS
Although dynamic preservation concepts are increasingly used in clinical practice, significant challenges remain. Specific financial pathways, uniform regulations, and tight collaborations among involved experts are needed to achieve wider global clinical use.
Identifiants
pubmed: 37297960
pii: jcm12113765
doi: 10.3390/jcm12113765
pmc: PMC10253826
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Artif Organs. 2022 Feb;46(2):296-305
pubmed: 34460943
Hemodial Int. 2022 Jul;26(3):287-294
pubmed: 35001500
Ann Surg. 2021 Nov 1;274(5):705-712
pubmed: 34334635
Am J Transplant. 2010 Feb;10(2):372-81
pubmed: 19958323
J Am Soc Nephrol. 2022 Nov;33(11):2059-2070
pubmed: 35981764
Transpl Int. 2018 May;31(5):566-567
pubmed: 29368360
Am J Transplant. 2022 Oct;22(10):2401-2408
pubmed: 35671067
Hepatology. 2023 Apr 5;:
pubmed: 37013926
Health Aff (Millwood). 2018 Oct;37(10):1570-1577
pubmed: 30273022
N Engl J Med. 2021 Apr 15;384(15):1391-1401
pubmed: 33626248
Updates Surg. 2022 Apr;74(2):501-510
pubmed: 35226307
Ann Surg. 2022 Jun 1;275(6):1156-1164
pubmed: 35258511
Nephrol Dial Transplant. 2008 Jun;23(6):1982-9
pubmed: 18174268
Lancet. 2020 Nov 21;396(10263):1653-1662
pubmed: 33220737
JAMA Surg. 2022 Mar 01;157(3):189-198
pubmed: 34985503
Nat Commun. 2020 Jun 16;11(1):2939
pubmed: 32546694
Clin Transplant. 2019 Oct;33(10):e13659
pubmed: 31278776
Am J Transplant. 2012 Jul;12(7):1824-30
pubmed: 22578189
BMJ Open. 2016 Oct 7;6(10):e012062
pubmed: 27855091
Liver Transpl. 2021 Feb;27(3):349-362
pubmed: 33237618
Am J Transplant. 2022 Apr;22(4):1169-1181
pubmed: 34856070
Transplantation. 2018 May;102(5):e211-e218
pubmed: 29702538
Br J Surg. 2022 Feb 1;109(2):e31-e32
pubmed: 34904161
Ann Surg. 2010 Apr;251(4):743-8
pubmed: 20224367
Am J Transplant. 2019 Jun;19(6):1745-1758
pubmed: 30589499
Artif Organs. 2022 Feb;46(2):191-200
pubmed: 34878658
Artif Organs. 2022 Dec;46(12):2511-2517
pubmed: 36149237
J Clin Med. 2022 Sep 03;11(17):
pubmed: 36079148
Liver Transpl. 2020 Nov;26(11):1516-1521
pubmed: 32531132
Nature. 2018 May;557(7703):50-56
pubmed: 29670285
Am J Transplant. 2018 Aug;18(8):1865-1874
pubmed: 29791060
J Hepatol. 2022 Feb;76(2):371-382
pubmed: 34655663
Transplantation. 2022 Dec 1;106(12):2295-2298
pubmed: 36044358