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Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver
BACKGROUND. Aberrant hepatic arterial anatomy may be seen in up to 30% of liver grafts, and reconstruction prolongs the cold ischemic time or the arterialization times. If normothermic machine preservation (NMP) is used to preserve liver grafts, the presence of aberrant arterial anatomy poses a chal...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447422/ https://www.ncbi.nlm.nih.gov/pubmed/32904023 http://dx.doi.org/10.1097/TXD.0000000000001040 |
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author | Nasralla, David Lembach, Hanns Mergental, Hynek Mirza, Darius Friend, Peter Muiesan, Paolo Perera, MTPR |
author_facet | Nasralla, David Lembach, Hanns Mergental, Hynek Mirza, Darius Friend, Peter Muiesan, Paolo Perera, MTPR |
author_sort | Nasralla, David |
collection | PubMed |
description | BACKGROUND. Aberrant hepatic arterial anatomy may be seen in up to 30% of liver grafts, and reconstruction prolongs the cold ischemic time or the arterialization times. If normothermic machine preservation (NMP) is used to preserve liver grafts, the presence of aberrant arterial anatomy poses a challenge. Dual arterial cannulation is a temporary solution to enable effective perfusion, until optimal circumstances are met for arterial reconstruction, without compromising ischemia time. To date the technical and logistical feasibility of arterial reconstruction ex situ and during NMP has not been reported. METHODS. Series of 5 cases from the Consortium for Organ Preservation in Europe randomized controlled trial in which grafts with arterial anatomic variations were reconstructed while organs were perfused on NMP. RESULTS. One donor after cardiac death and 4 donor after brain death livers with arterial anatomical variations reconstructed while on NMP were included. All patients survived transplantation, spending 1–7 d in intensive care unit and discharged home after 5–15 d. None of the cases developed early allograft dysfunction or any early technical complications. At follow-up, there were no late hepatic artery thrombosis, stenosis, or any other vascular–related complication. Four of 5 patients underwent magnetic resonance cholangiopancreatography at 6 mo with no evidence of ischemic cholangiopathy. CONCLUSIONS. The case series described above suggests that ex vivo arterial reconstruction surgery on liver grafts while on board the NMP device is feasible, safe, and effective. |
format | Online Article Text |
id | pubmed-7447422 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-74474222020-09-04 Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver Nasralla, David Lembach, Hanns Mergental, Hynek Mirza, Darius Friend, Peter Muiesan, Paolo Perera, MTPR Transplant Direct Liver Transplantation BACKGROUND. Aberrant hepatic arterial anatomy may be seen in up to 30% of liver grafts, and reconstruction prolongs the cold ischemic time or the arterialization times. If normothermic machine preservation (NMP) is used to preserve liver grafts, the presence of aberrant arterial anatomy poses a challenge. Dual arterial cannulation is a temporary solution to enable effective perfusion, until optimal circumstances are met for arterial reconstruction, without compromising ischemia time. To date the technical and logistical feasibility of arterial reconstruction ex situ and during NMP has not been reported. METHODS. Series of 5 cases from the Consortium for Organ Preservation in Europe randomized controlled trial in which grafts with arterial anatomic variations were reconstructed while organs were perfused on NMP. RESULTS. One donor after cardiac death and 4 donor after brain death livers with arterial anatomical variations reconstructed while on NMP were included. All patients survived transplantation, spending 1–7 d in intensive care unit and discharged home after 5–15 d. None of the cases developed early allograft dysfunction or any early technical complications. At follow-up, there were no late hepatic artery thrombosis, stenosis, or any other vascular–related complication. Four of 5 patients underwent magnetic resonance cholangiopancreatography at 6 mo with no evidence of ischemic cholangiopathy. CONCLUSIONS. The case series described above suggests that ex vivo arterial reconstruction surgery on liver grafts while on board the NMP device is feasible, safe, and effective. Lippincott Williams & Wilkins 2020-08-21 /pmc/articles/PMC7447422/ /pubmed/32904023 http://dx.doi.org/10.1097/TXD.0000000000001040 Text en Copyright © 2020 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Liver Transplantation Nasralla, David Lembach, Hanns Mergental, Hynek Mirza, Darius Friend, Peter Muiesan, Paolo Perera, MTPR Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title | Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title_full | Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title_fullStr | Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title_full_unstemmed | Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title_short | Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver |
title_sort | ex situ arterial reconstruction during normothermic perfusion of the liver |
topic | Liver Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447422/ https://www.ncbi.nlm.nih.gov/pubmed/32904023 http://dx.doi.org/10.1097/TXD.0000000000001040 |
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