Upfront Normothermic Machine Perfusion for a Liver Graft with Severe Macrovesicular Steatosis: A Proof-of-Concept Case
Abstract
:1. Introduction
2. Case Description
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Perfusate Composition (Priming) | ||
Product | Dilution | Volume |
4% Succinylated gelatine | n/a | 500 mL |
Third party ABO-compatible PRBC | n/a | 3 units |
Meropenem | 500 mg/10 mL | 10 mL |
Heparin | 5000 u/mL | 2 mL |
10% calcium gluconate | 94 mg/mL | 10 mL |
8.4% sodium bicarbonate | 84 mg/mL | 20 mL * |
Infusion Solutions | ||
Product | Dilution | Infusion rate |
Sodium taurocholate | 5.6 g/30 mL | 1.25 mL/h |
Epoprostenol sodium | 0.25 mg/30 mL | 1.25 mL/h |
Heparin | 25,000 u/30 mL | 1.25 mL/h |
Insulin | 200 u/30 mL | 1.25 mL/h |
Parenteral Nutrition | ||
Product | Dilution | Infusion rate |
Clinimix E5/25 | n/a | 0.5 mL/min ** |
Author, Year | n | Intervention | Findings |
---|---|---|---|
Watson et al., 2018 [14] | 1 | End-ischemic NMP | One liver described as “very steatotic” was accepted for research but not transplanted. Perfusate ALT level was 7542 IU/L at 2 h and the liver showed no glucose metabolism |
Ceresa et al., 2019 [3] | 1 | End-ischemic NMP | Of 3 (9.7%) discarded livers, one DBD liver with 80% MaS was discarded due to insufficient lactate clearance, as well as lack of bile production and glucose metabolism |
Mergental et al., 2020 [9] | 2 | End-ischemic NMP | Of 9 (29%) discarded livers, 2 had moderate or severe MaS, respectively. Prevalence of medium-large droplet steatosis was higher among discarded livers (77.8% vs. 40.9%). No liver with MaS ≥ 30% was accepted for LT |
Fodor et al., 2021 [5] | 3 | End-ischemic NMP | Of 59 included patients, 3 (5.1%) received a liver with MaS ≥ 30%. Specific outcomes were not reported |
Patrono et al., 2022 [12] | 14 | End-ischemic NMP | Of 14 evaluated livers with MaS ≥ 30%, 10 (71%) were transplanted but 2 (14%) developed PNF. Graft function was good in the remaining patients |
He et al., 2018 [7] | 1 | IFLT | First report of IFLT in a liver from a DBD donor with 85–95% MaS. |
Chen et al., 2021 [4] | 26 | IFLT | Twenty-six livers with moderate (n = 16) or severe (n = 10) MaS were included, of which six were treated by IFLT. IFLT was associated with reduced AST, GGT and creatinine peak after LT, and lower EAD rate (0% vs. 60%, p = 0.001) |
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Patrono, D.; Apostu, A.L.; Rizza, G.; Cussa, D.; Barreca, A.; Limoncelli, S.; Mirabella, S.; Romagnoli, R. Upfront Normothermic Machine Perfusion for a Liver Graft with Severe Macrovesicular Steatosis: A Proof-of-Concept Case. Transplantology 2023, 4, 151-160. https://doi.org/10.3390/transplantology4030015
Patrono D, Apostu AL, Rizza G, Cussa D, Barreca A, Limoncelli S, Mirabella S, Romagnoli R. Upfront Normothermic Machine Perfusion for a Liver Graft with Severe Macrovesicular Steatosis: A Proof-of-Concept Case. Transplantology. 2023; 4(3):151-160. https://doi.org/10.3390/transplantology4030015
Chicago/Turabian StylePatrono, Damiano, Ana Lavinia Apostu, Giorgia Rizza, Davide Cussa, Antonella Barreca, Selene Limoncelli, Stefano Mirabella, and Renato Romagnoli. 2023. "Upfront Normothermic Machine Perfusion for a Liver Graft with Severe Macrovesicular Steatosis: A Proof-of-Concept Case" Transplantology 4, no. 3: 151-160. https://doi.org/10.3390/transplantology4030015