Past, Present, and Future of Dynamic Kidney and Liver Preservation and Resuscitation

I. Jochmans; M. Z. Akhtar; D. Nasralla; P. Kocabayoglu; C. Boffa; M. Kaisar; A. Brat; J. O'Callaghan; L. H. M. Pengel; S. Knight; R. J. Ploeg

Disclosures

American Journal of Transplantation. 2016;16(9):2545-2555. 

In This Article

Abstract and Introduction

Abstract

The increased demand for organs has led to the increased usage of "higher risk" kidney and liver grafts. These grafts from donation after circulatory death or expanded criteria donors are more susceptible to preservation injury and have a higher risk of unfavorable outcomes. Dynamic, instead of static, preservation could allow for organ optimization, offering a platform for viability assessment, active organ repair and resuscitation. Ex situ machine perfusion and in situ regional perfusion in the donor are emerging as potential tools to preserve and resuscitate vulnerable grafts. Preclinical findings have ignited clinical organ preservation research that investigates dynamic preservation, its various modes (continuous, preimplantation) and temperatures (hypo-, sub, or normothermic). This review outlines the current status of dynamic preservation of kidney and liver grafts and describes ongoing research and emerging clinical trials.

Introduction

The shortage of suitable organs for transplantation has resulted in the increased use of "higher risk" grafts. Kidneys and livers from donation after circulatory death (DCD) or from expanded criteria donors (ECDs) after brain death are particularly susceptible to the harmful effects of warm and cold ischemia and reperfusion injury. Consequently, these organs have an increased probability of developing initial graft dysfunction (delayed graft function [DGF] in kidney, early allograft dysfunction [EAD] in liver), primary nonfunction (PNF), biliary complications and decreased long-term graft survival.[1–5] Optimized organ-preservation strategies protecting these vulnerable grafts should allow organ viability assessment and resuscitation, reducing the unnecessary discard of organs. For this purpose, novel dynamic preservation strategies are being developed.

This overview outlines the current status of dynamic preservation of kidney and liver grafts and describes ongoing research and emerging clinical trials. These trials were identified by a thorough search of available online registry databases. Appendix S1 outlines the search strategy. Table S1 shows a nonexhaustive list of currently nonregistered trials identified through our network.

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