The future of organ perfusion and re-conditioning

Abstract

Organ preservation and re-conditioning using machine perfusion technologies continue to generate promising results in terms of viability assessment, organ utilization and improved initial graft function. Here, we summarize the latest findings and study the results of ex-vivo/ex-situ hypothermic (HMP) and normothermic machine perfusion (NMP) in the area of abdominal organ transplantation (kidney, liver, pancreas and intestine). We also consider the potential role of normothermic regional perfusion (NRP) to re-condition donors after circulatory death organs before retrieval. The findings from clinical studies reported to date suggest that machine perfusion will offer real benefits when compared with conventional cold preservation. Several randomized trials are expected to report their findings within the next 2 years which may shed light on the relative merits of different perfusion methods and could indicate which perfusion parameters may be most useful to predict organ quality and viability. Further work is needed to identify composite endpoints that are relevant for transplanted organs that have undergone machine preservation. Multi-centre trials to compare and analyse the combinations of NRP followed by HMP and/or NMP, either directly after organ retrieval using transportable devices or when back-to-base, are needed. The potential applications of machine preservation technology beyond the field of solid organ transplantation are also considered.

Keywords: hypothermic; normothermic; organ preservation; regional perfusion; transplantation.

Figure 1

Future aspects of organ preservation and re‐conditioning with several possibilities to arrange preservation methods/technologies currently used clinically. Prospective randomized multicentre trials are needed to compare strategies (a–d) in regard to their effects and transplant outcomes. In addition, trials comparing (a–d) will deliver evidence if there are significant advantages/disadvantages of starting preservation using perfusion devices immediately after organ retrieval or in a back‐to‐base/hub approach following static cold storage. *Re‐Conditioning offers viability assessment of the organ, treatment of the organ with supplemental biologicals and stem cells as therapeutic agents. Pharmacological testing can be undertaken. The treatment to be applied or the drug/substance to be tested will determine if oxygenated hypothermic machine perfusion is enough or if a nearly physiological environment at 37 °C is needed.