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Long-term normothermic machine preservation of human livers
- Source :
- American Journal of Physiology-Gastrointestinal and Liver Physiology. 322(2):183-200
- Publication Year :
- 2022
- Publisher :
- AMER PHYSIOLOGICAL SOC, 2022.
-
Abstract
- Although short‐term machine perfusion (≤24 h) allows for resuscitation and viability assessment of high‐risk donor livers, the donor organ shortage might be further remedied by long‐term perfusion machines. Extended preservation of injured donor livers may allow reconditioning, repairing, and regeneration. This review summarizes the necessary requirements and challenges for long‐term liver machine preservation, which requires integrating multiple core physiological functions to mimic the physiological environment inside the body. A pump simulates the heart in the perfusion system, including automatically controlled adjustment of flow and pressure settings. Oxygenation and ventilation are required to account for the absence of the lungs combined with continuous blood gas analysis. To avoid pressure necrosis and achieve heterogenic tissue perfusion during preservation, diaphragm movement should be simulated. An artificial kidney is required to remove waste products and control the perfusion solution’s composition. The perfusate requires an oxygen carrier, but will also be challenged by coagulation and activation of the immune system. The role of the pancreas can be mimicked through closed‐loop control of glucose concentrations by automatic injection of insulin or glucagon. Nutrients and bile salts, generally transported from the intestine to the liver, have to be supplemented when preserving livers long term. Especially for long‐term perfusion, the container should allow maintenance of sterility. In summary, the main challenge to develop a long‐term perfusion machine is to maintain the liver’s homeostasis in a sterile, carefully controlled environment. Long‐term machine preservation of human livers may allow organ regeneration and repair, thereby ultimately solving the shortage of donor livers.
- Subjects :
- ORGAN PRESERVATION
isolated liver perfusion
liver transplantation
CARDIOPULMONARY BYPASS
KIDNEY PERFUSION
BLOOD-FLOW
TRANSPLANTATION
machine perfusion
PERFUSION SYSTEM
PRIMARY NONFUNCTION
liver preservation
EXTRACORPOREAL MEMBRANE-OXYGENATION
liver physiology
FUNCTIONAL ASSESSMENT
COMPLEMENT ACTIVATION
Subjects
Details
- Language :
- English
- ISSN :
- 15221547 and 01931857
- Volume :
- 322
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- American Journal of Physiology-Gastrointestinal and Liver Physiology
- Accession number :
- edsair.dris...01423..5464cefbd636286adcb564926ef1f826