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Lui JK, Spaho L, Hakimian S, Devine M, Bui R, Touray S, Holzwanger E, Patel B, Ellis D, Fridlyand S, Ogunsua AA, Mahboub P, Daly JS, Bozorgzadeh A, Kopec SE. Pleural Effusions Following Liver Transplantation: A Single-Center Experience. J Intensive Care Med 2020; 36:862-872. [PMID: 32527176 DOI: 10.1177/0885066620932448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. RESULTS In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. CONCLUSIONS In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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Affiliation(s)
- Justin K Lui
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Lidia Spaho
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Shahrad Hakimian
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Michael Devine
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosa Bui
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Sunkaru Touray
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA.,Carlsbad Medical Center, NM, USA
| | - Erik Holzwanger
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Boskey Patel
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Ellis
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Svetlana Fridlyand
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Adedotun A Ogunsua
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiology, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Paria Mahboub
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Daly
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Division of Infectious Diseases, 3354University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott E Kopec
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA
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2
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Raigani S, Karimian N, Huang V, Zhang AM, Beijert I, Geerts S, Nagpal S, Hafiz EOA, Fontan FM, Aburawi MM, Mahboub P, Markmann JF, Porte RJ, Uygun K, Yarmush M, Yeh H. Metabolic and lipidomic profiling of steatotic human livers during ex situ normothermic machine perfusion guides resuscitation strategies. PLoS One 2020; 15:e0228011. [PMID: 31978172 PMCID: PMC6980574 DOI: 10.1371/journal.pone.0228011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/06/2020] [Indexed: 12/15/2022] Open
Abstract
There continues to be a significant shortage of donor livers for transplantation. One impediment is the discard rate of fatty, or steatotic, livers because of their poor post-transplant function. Steatotic livers are prone to significant ischemia-reperfusion injury (IRI) and data regarding how best to improve the quality of steatotic livers is lacking. Herein, we use normothermic (37°C) machine perfusion in combination with metabolic and lipidomic profiling to elucidate deficiencies in metabolic pathways in steatotic livers, and to inform strategies for improving their function. During perfusion, energy cofactors increased in steatotic livers to a similar extent as non-steatotic livers, but there were significant deficits in anti-oxidant capacity, efficient energy utilization, and lipid metabolism. Steatotic livers appeared to oxidize fatty acids at a higher rate but favored ketone body production rather than energy regeneration via the tricyclic acid cycle. As a result, lactate clearance was slower and transaminase levels were higher in steatotic livers. Lipidomic profiling revealed ω-3 polyunsaturated fatty acids increased in non-steatotic livers to a greater extent than in steatotic livers. The novel use of metabolic and lipidomic profiling during ex situ normothermic machine perfusion has the potential to guide the resuscitation and rehabilitation of steatotic livers for transplantation.
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Affiliation(s)
- Siavash Raigani
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Negin Karimian
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Viola Huang
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Anna M. Zhang
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Irene Beijert
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sharon Geerts
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sonal Nagpal
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Ehab O. A. Hafiz
- Electron Microscopy Research Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Fermin M. Fontan
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Mohamed M. Aburawi
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Paria Mahboub
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - James F. Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert J. Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Korkut Uygun
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Martin Yarmush
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, Massachusetts, United States of America
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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3
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Karimian N, Raigani S, Huang V, Nagpal S, Hafiz EOA, Beijert I, Mahboub P, Porte RJ, Uygun K, Yarmush M, Yeh H. Subnormothermic Machine Perfusion of Steatotic Livers Results in Increased Energy Charge at the Cost of Anti-Oxidant Capacity Compared to Normothermic Perfusion. Metabolites 2019; 9:E246. [PMID: 31652927 PMCID: PMC6918199 DOI: 10.3390/metabo9110246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022] Open
Abstract
There continues to be significant debate regarding the most effective mode of ex situ machine perfusion of livers for transplantation. Subnormothermic (SNMP) and normothermic machine perfusion (NMP) are two methods with different benefits. We examined the metabolomic profiles of discarded steatotic human livers during three hours of subnormothermic or normothermic machine perfusion. Steatotic livers regenerate higher stores of ATP during SNMP than NMP. However, there is a significant depletion of available glutathione during SNMP, likely due to an inability to overcome the high energy threshold needed to synthesize glutathione. This highlights the increased oxidative stress apparent in steatotic livers. Rescue of discarded steatotic livers with machine perfusion may require the optimization of redox status through repletion or supplementation of reducing agents.
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Affiliation(s)
- Negin Karimian
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Siavash Raigani
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Viola Huang
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Sonal Nagpal
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Ehab O A Hafiz
- Electron Microscopy Research Department, Theodor Bilharz Research Institute, 12411 Giza, Egypt.
| | - Irene Beijert
- Division of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, 9700 Groningen, The Netherlands.
| | - Paria Mahboub
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Robert J Porte
- Division of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, 9700 Groningen, The Netherlands.
| | - Korkut Uygun
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
| | - Martin Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA.
| | - Heidi Yeh
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Shriners Hospital for Children, Boston, MA 02114, USA.
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4
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Aburawi MM, Fontan FM, Karimian N, Eymard C, Cronin S, Pendexter C, Nagpal S, Banik P, Ozer S, Mahboub P, Delmonico FL, Yeh H, Uygun K, Markmann JF. Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion. Am J Transplant 2019; 19:2814-2824. [PMID: 30938927 PMCID: PMC6763345 DOI: 10.1111/ajt.15375] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/26/2019] [Accepted: 03/20/2019] [Indexed: 01/25/2023]
Abstract
Normothermic machine perfusion presents a novel platform for pretransplant assessment and reconditioning of kidney grafts. Maintaining the metabolic activity of a preserved graft at physiologic levels requires an adequate oxygen supply, typically delivered by crystalloid solutions supplemented with red blood cells. In this study, we explored the feasibility of using a synthetic hemoglobin-based oxygen carrier (HBOC) in human kidney normothermic perfusion. Fourteen discarded human kidneys were perfused for 6 hours at a mean temperature of 37°C using a pressure-controlled system. Kidneys were perfused with a perfusion solution supplemented with either HBOC (n = 7) or packed red blood cells (PRBC) (n = 7) to increase oxygen-carrying capacity. Renal artery resistance, oxygen extraction, metabolic activity, energy stores, and histological features were evaluated. Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding vascular flow (P = .66), oxygen consumption (P = .88), and reconstitution of tissue adenosine triphosphate (P = .057). Lactic acid levels were significantly higher in kidneys perfused with PRBC (P = .007). Histological findings were comparable between groups, and there was no evidence of histological damage caused by the HBOC. This feasibility experiment demonstrates that a HBOC solution can offer a logistically more convenient off-the-shelf alternative to PRBC in normothermic machine perfusion of human kidneys.
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Affiliation(s)
- Mohamed M Aburawi
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fermin M Fontan
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Negin Karimian
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Corey Eymard
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Cronin
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Casie Pendexter
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sonal Nagpal
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peony Banik
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sinan Ozer
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paria Mahboub
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis L Delmonico
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,New England Donor Services, Waltham, Massachusetts
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Korkut Uygun
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James F Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Mahboub P, Aburawi M, Karimian N, Lin F, Karabacak M, Fontan F, Tessier SN, Markmann J, Yeh H, Uygun K. The efficacy of HBOC-201 in ex situ gradual rewarming kidney perfusion in a rat model. Artif Organs 2019; 44:81-90. [PMID: 31368159 PMCID: PMC6916591 DOI: 10.1111/aor.13534] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/03/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
Gradual rewarming from hypothermic to normothermic is a novel perfusion modality with superior outcome to sudden rewarming to normothermic. However, the identification of an oxygen carrier that could function at a temperature range from 4 to 7°C or whether it is necessary to use oxygen carrier during kidney rewarming, remains unresolved. This study was designed to test the use of a hemoglobin‐based oxygen carrier (HBOC) during gradual kidney rewarming as an alternative to simple dissolved oxygen. In this study, 10 rat kidneys were randomly divided into the control and the HBOC group. In the control group, no oxygen carrier was used during rewarming perfusion and the perfusion solution was oxygenated only by applying diffused carbogen flow. The protocol mimicked a donor after circulatory death (DCD) kidney transplantation, where after 30 minutes warm ischemia and 120 minutes cold storage in University of Wisconsin solution, the DCD kidneys underwent gradual rewarming from 10 to 37°C during 90 minutes with or without HBOC. This was followed by 30 minutes of warm ischemia in room temperature to mimic the anastomosis time and 120 minutes of reperfusion at 37°C to mimic the early post‐transplant state of the graft. The HBOC group demonstrated superior kidney function which was highlighted by higher ultrafiltrate production, better glomerular filtration rate and improved sodium reabsorption. There was no significant difference between the 2 groups regarding the hemodynamics, tissue injury, and adenosine triphosphate levels. In conclusion, this study suggests better renal function recovery in DCD kidneys after rewarming with HBOC compared to rewarming without an oxygen carrier.
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Affiliation(s)
- Paria Mahboub
- University Medical Center Groningen, Groningen, Netherlands.,Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Aburawi
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Negin Karimian
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Florence Lin
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Murat Karabacak
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fermin Fontan
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shannon N Tessier
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Markmann
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Heidi Yeh
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Korkut Uygun
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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6
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Martins PN, Rawson A, Movahedi B, Brüggenwirth IMA, Dolgin NH, Martins AB, Mahboub P, Bozorgzadeh A. Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels. EXP CLIN TRANSPLANT 2019; 17:498-506. [DOI: 10.6002/ect.2017.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Hobbenaghi R, Mahboub P, Saifzadeh S, Javanbakht J, Manesh JYY, Mortezaee R, Touni SR, Hosseini E, Aghajanshakeri S, Moloudizargari M, Javaherypour S. Erratum to: Histopathological features of bone regeneration in a canine segmental ulnar defect model. Diagn Pathol 2016; 11:84. [PMID: 27613500 PMCID: PMC5018184 DOI: 10.1186/s13000-016-0534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rahim Hobbenaghi
- Department of Pathology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Paria Mahboub
- Graduate, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Siamak Saifzadeh
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, Qld, 4059, Australia
| | - Javad Javanbakht
- Department of Pathobiology, Faculty of Veterinary Medicine, Tehran University, Tehran, Iran.
| | - Javad Yaghoobi Yeganeh Manesh
- Gradute of Islamic Azad University of bShahrekord, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Rasool Mortezaee
- Student of Ferdowsi University of Mashhad, Faculty of Veterinary Medicine, Ferdowsi University, Mashahd, Iran
| | - Seyed Rashid Touni
- Ph.D Student of Anatomy and Embryology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Ehsan Hosseini
- Faculty of Para Veterinary Medicine, Ilam University, Ilam, Iran
| | - Shahin Aghajanshakeri
- Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Milad Moloudizargari
- Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Soheil Javaherypour
- Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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8
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Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6:314-320. [PMID: 27358776 PMCID: PMC4919735 DOI: 10.5500/wjt.v6.i2.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/23/2015] [Accepted: 03/25/2016] [Indexed: 02/05/2023] Open
Abstract
There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft’s for transplantation, improve the outcomes, and decrease the mortality on the waiting list.
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9
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Mahboub P, Ottens P, Seelen M, 't Hart N, Van Goor H, Ploeg R, Martins PN, Leuvenink H. Correction: Gradual Rewarming with Gradual Increase in Pressure during Machine Perfusion after Cold Static Preservation Reduces Kidney Ischemia Reperfusion Injury. PLoS One 2016; 11:e0152006. [PMID: 26977593 PMCID: PMC4792428 DOI: 10.1371/journal.pone.0152006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Mahboub P, Ottens P, Seelen M, t Hart N, Van Goor H, Ploeg R, Martins P, Leuvenink H. Gradual Rewarming with Gradual Increase in Pressure during Machine Perfusion after Cold Static Preservation Reduces Kidney Ischemia Reperfusion Injury. PLoS One 2015; 10:e0143859. [PMID: 26630031 PMCID: PMC4667888 DOI: 10.1371/journal.pone.0143859] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/09/2015] [Indexed: 01/09/2023] Open
Abstract
In this study we evaluated whether gradual rewarming after the period of cold ischemia would improve organ quality in an Isolated Perfused Kidney Model. Left rat kidneys were statically cold stored in University of Wisconsin solution for 24 hours at 4°C. After cold storage kidneys were rewarmed in one of three ways: perfusion at body temperature (38°C), or rewarmed gradually from 10°C to 38°C with stabilization at 10°C for 30 min and rewarmed gradually from 10°C to 38°C with stabilization at 25°C for 30 min. In the gradual rewarming groups the pressure was increased stepwise to 40 mmHg at 10°C and 70 mmHg at 25°C to counteract for vasodilatation leading to low perfusate flows. Renal function parameters and injury biomarkers were measured in perfusate and urine samples. Increases in injury biomarkers such as aspartate transaminase and lactate dehydrogenase in the perfusate were lower in the gradual rewarming groups versus the control group. Sodium re-absorption was improved in the gradual rewarming groups and reached significance in the 25°C group after ninety minutes of perfusion. HSP-70, ICAM-1, VCAM-1 mRNA expressions were decreased in the 10°C and 25°C groups. Based on the data kidneys that underwent gradual rewarming suffered less renal parenchymal, tubular injury and showed better endothelial preservation. Renal function improved in the gradual rewarming groups versus the control group.
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Affiliation(s)
- Paria Mahboub
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Dept. of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA, United States of America
| | - Petra Ottens
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc Seelen
- Dept of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nails t Hart
- Dept of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry Van Goor
- Dept of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Paulo Martins
- Dept. of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA, United States of America
| | - Henri Leuvenink
- Dept of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
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Westerkamp AC, Mahboub P, Meyer SL, Hottenrott M, Ottens PJ, Wiersema-Buist J, Gouw ASH, Lisman T, Leuvenink HGD, Porte RJ. End-ischemic machine perfusion reduces bile duct injury in donation after circulatory death rat donor livers independent of the machine perfusion temperature. Liver Transpl 2015; 21:1300-11. [PMID: 26097213 DOI: 10.1002/lt.24200] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/06/2015] [Accepted: 06/08/2015] [Indexed: 12/20/2022]
Abstract
A short period of oxygenated machine perfusion (MP) after static cold storage (SCS) may reduce biliary injury in donation after cardiac death (DCD) donor livers. However, the ideal perfusion temperature for protection of the bile ducts is unknown. In this study, the optimal perfusion temperature for protection of the bile ducts was assessed. DCD rat livers were preserved by SCS for 6 hours. Thereafter, 1 hour of oxygenated MP was performed using either hypothermic machine perfusion, subnormothermic machine perfusion, or with controlled oxygenated rewarming (COR) conditions. Subsequently, graft and bile duct viability were assessed during 2 hours of normothermic ex situ reperfusion. In the MP study groups, lower levels of transaminases, lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances were measured compared to SCS. In parallel, mitochondrial oxygen consumption and adenosine triphosphate (ATP) production were significantly higher in the MP groups. Biomarkers of biliary function, including bile production, biliary bicarbonate concentration, and pH, were significantly higher in the MP groups, whereas biomarkers of biliary epithelial injury (biliary gamma-glutamyltransferase [GGT] and LDH), were significantly lower in MP preserved livers. Histological analysis revealed less injury of large bile duct epithelium in the MP groups compared to SCS. In conclusion, compared to SCS, end-ischemic oxygenated MP of DCD livers provides better preservation of biliary epithelial function and morphology, independent of the temperature at which MP is performed. End-ischemic oxygenated MP could reduce biliary injury after DCD liver transplantation.
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Affiliation(s)
- Andrie C Westerkamp
- Surgical Research Laboratory.,Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery
| | | | - Sophie L Meyer
- Surgical Research Laboratory.,Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery
| | | | | | | | - Annette S H Gouw
- Departments of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Surgical Research Laboratory.,Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery
| | | | - Robert J Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery
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Mahboub P, Ottens P, Ploeg R, Leuvenink H. Gradual warming-up of kidneys reduces injury compared to immediate reperfusion. Transpl Immunol 2014. [DOI: 10.1016/j.trim.2014.11.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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