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Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion
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 speci...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106107/ https://www.ncbi.nlm.nih.gov/pubmed/36117430 http://dx.doi.org/10.1002/lt.26574 |
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author | Patrono, Damiano De Carlis, Riccardo Gambella, Alessandro Farnesi, Francesca Podestà, Alice Lauterio, Andrea Tandoi, Francesco De Carlis, Luciano Romagnoli, Renato |
author_facet | Patrono, Damiano De Carlis, Riccardo Gambella, Alessandro Farnesi, Francesca Podestà, Alice Lauterio, Andrea Tandoi, Francesco De Carlis, Luciano Romagnoli, Renato |
author_sort | Patrono, Damiano |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10106107 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-101061072023-04-17 Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion Patrono, Damiano De Carlis, Riccardo Gambella, Alessandro Farnesi, Francesca Podestà, Alice Lauterio, Andrea Tandoi, Francesco De Carlis, Luciano Romagnoli, Renato Liver Transpl Original Articles: Liver Surgery and Organ Preservation 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. Lippincott Williams & Wilkins 2023-05 2022-10-10 /pmc/articles/PMC10106107/ /pubmed/36117430 http://dx.doi.org/10.1002/lt.26574 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (https://creativecommons.org/licenses/by/4.0/) (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Original Articles: Liver Surgery and Organ Preservation Patrono, Damiano De Carlis, Riccardo Gambella, Alessandro Farnesi, Francesca Podestà, Alice Lauterio, Andrea Tandoi, Francesco De Carlis, Luciano Romagnoli, Renato Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title | Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title_full | Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title_fullStr | Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title_full_unstemmed | Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title_short | Viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
title_sort | viability assessment and transplantation of fatty liver grafts using end‐ischemic normothermic machine perfusion |
topic | Original Articles: Liver Surgery and Organ Preservation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106107/ https://www.ncbi.nlm.nih.gov/pubmed/36117430 http://dx.doi.org/10.1002/lt.26574 |
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