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Opportunities for Therapeutic Intervention During Machine Perfusion

  • Tissue Engineering and Regeneration (J Wertheim, Section Editor)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There is a vast discrepancy between the number of patients waiting for organ transplantation and the available donor organs. Ex situ machine perfusion (MP) has emerged in an effort to expand the donor pool, by improving organ preservation, providing diagnostic information, and more recently, acting as a platform for organ improvement. This article reviews the current status of MP with a focus on its role in organ pre-conditioning and therapeutic interventions prior to transplantation.

Recent Findings

MP has allowed longer organ preservation compared to conventional static cold storage and allowed the use of organs that might otherwise have been discarded. Moreover, experimental studies have investigated the role of MP in reducing ischemia reperfusion injury of lungs, kidneys, and livers by applying mesenchymal stem cells (MSCs), anti-inflammatory agents, cytotopic anti-coagulants, and defatting cocktails.

Summary

MP has opened a new era in the field of organ transplantation and tissue medication.

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Abbreviations

OPTN:

Organ Procurement and Transplantation Network

UNOS:

United Network for Organ Sharing

ECD:

Extended criteria donor

DCD:

Donation after circulatory death

SCS:

Static cold storage

MP:

Machine perfusion

HMP:

Hypothermic machine perfusion

SNMP:

Subnormothermic machine perfusion

NMP:

Normothermic machine perfusion

NRP:

Normothermic regional perfusion

COR:

Controlled oxygenated rewarming

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

PNF:

Primary non-function

EAD:

Early allograft dysfunction

HCV:

Hepatitis C

IRI:

Ischemia reperfusion injury

ROS:

Reactive oxygen species

NO:

Nitric oxide

ATP:

Adenosine triphosphate

cAMP:

Cyclic adenosine monophosphate

CVR:

Coronary vascular resistance

MVO2 :

Myocardial oxygen consumption

PaO2/FiO2 :

Partial pressure of oxygen/fraction of inspired oxygen

CFTR:

Cystic fibrosis transmembrane conductance regulator

APRV:

Airway pressure release ventilation

IL:

Interleukin

TNF-α:

Tumor necrosis factor-α

VEGF:

Vascular endothelial growth factor

ET-1:

Endothelin-1

KIM-1:

Kidney injury molecule-1

NGAL:

Neutrophil gelatinase-associated lipocalin

MSCs:

Mesenchymal stem cells

TG:

Triglyceride

FFA:

Free fatty acids

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Authors and Affiliations

  1. Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WHT 5, Boston, MA, 02114, USA

    Negin Karimian & Heidi Yeh

  2. Center for Engineering in Medicine, Harvard Medical School, Boston, MA, USA

    Negin Karimian

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  1. Negin Karimian
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Negin Karimian and Heidi Yeh declare no conflict of interest.

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Karimian, N., Yeh, H. Opportunities for Therapeutic Intervention During Machine Perfusion. Curr Transpl Rep 4, 141–148 (2017). https://doi.org/10.1007/s40472-017-0144-y

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