Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia
Objective: to analyze a clinical case series and evaluate the safety and efficacy of a sequential machine perfusion protocol combining dual hypothermic oxygenated perfusion (D-HOPE) and normothermic machine perfusion (NMP) for conditioning and viability assessment of liver grafts retrieved from expa...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov
2025-07-01
|
| Series: | Вестник трансплантологии и искусственных органов |
| Subjects: | |
| Online Access: | https://journal.transpl.ru/vtio/article/view/1967 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849242185612918784 |
|---|---|
| author | S. V. Gautier N. V. Grudinin A. R. Monakhov M. A. Boldyrev V. K. Bogdanov D. M. Bondarenko S. I. Zubenko N. P. Mozheiko M. G. Minina O. M. Tsirulnikova |
| author_facet | S. V. Gautier N. V. Grudinin A. R. Monakhov M. A. Boldyrev V. K. Bogdanov D. M. Bondarenko S. I. Zubenko N. P. Mozheiko M. G. Minina O. M. Tsirulnikova |
| author_sort | S. V. Gautier |
| collection | DOAJ |
| description | Objective: to analyze a clinical case series and evaluate the safety and efficacy of a sequential machine perfusion protocol combining dual hypothermic oxygenated perfusion (D-HOPE) and normothermic machine perfusion (NMP) for conditioning and viability assessment of liver grafts retrieved from expanded criteria donors (ECD) in routine clinical practice.Materials and methods. Between November and December 2024, two sessions of combined D-HOPE followed by NMP were conducted at Shumakov National Medical Research Center of Transplantology and Artificial Organs («Shumakov Research Center») using liver allografts obtained from ECD after brain death. Following an initial period of static cold storage (SCS), machine perfusion was initiated using a circulatory assist device. A histidine-tryptophan-ketoglutarate (HTK)-based perfusate was used during the DHOPE phase, while a red blood cell (RBC) suspension was used during the NMP stage. Throughout perfusion, temperature and hemodynamic parameters were continuously monitored and maintained. Laboratory parameters were assessed at designated intervals, in accordance with the institutional protocol developed at Shumakov Research Center.Results. Allograft #1 was deemed non-viable due to elevated lactate levels after 3 hours of perfusion and lack of glucose metabolism. The preservation times were as follows: SCS – 424 minutes, D-HOPE – 120 minutes, NMP – 300 minutes, totaling 844 minutes. Allograft #2 met the viability criteria and was successfully transplanted. Preservation times were: SCS – 260 minutes, D-HOPE – 124 minutes, NMP – 480 minutes, with a total preservation time of 884 minutes. Post-transplant peak levels of AST, ALT, and total bilirubin in the recipient were 922.5 U/L, 613 U/L, and 63.3 μmol/L, respectively. The only postoperative complication was acute kidney injury, managed with two sessions of hemodialysis. The patient was discharged after 14 days of hospitalization without need for readmission. At the time of writing, the patient is alive and complication-free, with a follow-up period of 3 months.Conclusions. Combined machine perfusion of liver grafts appears to be a safe and effective strategy to mitigate ischemia-reperfusion and preservation-related injury in liver transplantation. It also facilitates viability assessment of marginal liver grafts, reduces potential recipient complications, and expands the donor pool through the use of allografts from ECD. |
| format | Article |
| id | doaj-art-24d6f4f51e554d6a928ed169eca32e62 |
| institution | Kabale University |
| issn | 1995-1191 |
| language | Russian |
| publishDate | 2025-07-01 |
| publisher | Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov |
| record_format | Article |
| series | Вестник трансплантологии и искусственных органов |
| spelling | doaj-art-24d6f4f51e554d6a928ed169eca32e622025-08-20T03:59:53ZrusFederal Research Center of Transplantology and Artificial Organs named after V.I.ShumakovВестник трансплантологии и искусственных органов1995-11912025-07-0127282210.15825/1995-1191-2025-2-8-221361Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in RussiaS. V. Gautier0N. V. Grudinin1A. R. Monakhov2M. A. Boldyrev3V. K. Bogdanov4D. M. Bondarenko5S. I. Zubenko6N. P. Mozheiko7M. G. Minina8O. M. Tsirulnikova9Shumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov UniversityShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov UniversityShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial OrganShumakov National Medical Research Center of Transplantology and Artificial Organ; Botkin HospitalShumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov UniversityObjective: to analyze a clinical case series and evaluate the safety and efficacy of a sequential machine perfusion protocol combining dual hypothermic oxygenated perfusion (D-HOPE) and normothermic machine perfusion (NMP) for conditioning and viability assessment of liver grafts retrieved from expanded criteria donors (ECD) in routine clinical practice.Materials and methods. Between November and December 2024, two sessions of combined D-HOPE followed by NMP were conducted at Shumakov National Medical Research Center of Transplantology and Artificial Organs («Shumakov Research Center») using liver allografts obtained from ECD after brain death. Following an initial period of static cold storage (SCS), machine perfusion was initiated using a circulatory assist device. A histidine-tryptophan-ketoglutarate (HTK)-based perfusate was used during the DHOPE phase, while a red blood cell (RBC) suspension was used during the NMP stage. Throughout perfusion, temperature and hemodynamic parameters were continuously monitored and maintained. Laboratory parameters were assessed at designated intervals, in accordance with the institutional protocol developed at Shumakov Research Center.Results. Allograft #1 was deemed non-viable due to elevated lactate levels after 3 hours of perfusion and lack of glucose metabolism. The preservation times were as follows: SCS – 424 minutes, D-HOPE – 120 minutes, NMP – 300 minutes, totaling 844 minutes. Allograft #2 met the viability criteria and was successfully transplanted. Preservation times were: SCS – 260 minutes, D-HOPE – 124 minutes, NMP – 480 minutes, with a total preservation time of 884 minutes. Post-transplant peak levels of AST, ALT, and total bilirubin in the recipient were 922.5 U/L, 613 U/L, and 63.3 μmol/L, respectively. The only postoperative complication was acute kidney injury, managed with two sessions of hemodialysis. The patient was discharged after 14 days of hospitalization without need for readmission. At the time of writing, the patient is alive and complication-free, with a follow-up period of 3 months.Conclusions. Combined machine perfusion of liver grafts appears to be a safe and effective strategy to mitigate ischemia-reperfusion and preservation-related injury in liver transplantation. It also facilitates viability assessment of marginal liver grafts, reduces potential recipient complications, and expands the donor pool through the use of allografts from ECD.https://journal.transpl.ru/vtio/article/view/1967ex vivo perfusionliver transplantationmachine perfusion |
| spellingShingle | S. V. Gautier N. V. Grudinin A. R. Monakhov M. A. Boldyrev V. K. Bogdanov D. M. Bondarenko S. I. Zubenko N. P. Mozheiko M. G. Minina O. M. Tsirulnikova Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia Вестник трансплантологии и искусственных органов ex vivo perfusion liver transplantation machine perfusion |
| title | Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia |
| title_full | Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia |
| title_fullStr | Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia |
| title_full_unstemmed | Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia |
| title_short | Combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor: first clinical application in Russia |
| title_sort | combined sequential hypothermic oxygenated and normothermic machine perfusion for liver transplant from an expanded criteria donor first clinical application in russia |
| topic | ex vivo perfusion liver transplantation machine perfusion |
| url | https://journal.transpl.ru/vtio/article/view/1967 |
| work_keys_str_mv | AT svgautier combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT nvgrudinin combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT armonakhov combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT maboldyrev combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT vkbogdanov combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT dmbondarenko combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT sizubenko combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT npmozheiko combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT mgminina combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia AT omtsirulnikova combinedsequentialhypothermicoxygenatedandnormothermicmachineperfusionforlivertransplantfromanexpandedcriteriadonorfirstclinicalapplicationinrussia |