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Am J Transplant. 2018 Mar;18(3):737-744. doi: 10.1111/ajt.14583. Epub 2017 Dec 9.

The first case of ischemia-free organ transplantation in humans: A proof of concept.

He X1,2,3, Guo Z1,2,3, Zhao Q1,2,3, Ju W1,2,3, Wang D1,2,3, Wu L1,2,3, Yang L4, Ji F1,2,3, Tang Y1,2,3, Zhang Z1,2,3, Huang S1,2,3, Wang L1,2,3, Zhu Z1,2,3, Liu K1,2,3, Zhu Y5, Gao Y1,2,3, Xiong W4, Han M1,2,3, Liao B2,6, Chen M1,2,3, Ma Y1,2,3, Zhu X1,2,3, Huang W4, Cai C7, Guan X7, Li XC1,2,3,8, Huang J1,9.

Author information

1
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
2
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
3
Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China.
4
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
5
Department of Cardiopulmonary Bypass, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
6
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
7
Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
8
Immunobiology and Transplant Science Center Houston Methodist Research Institute, Houston, TX, USA.
9
Peking Union Medical College Hospital, Beijing, China.

Abstract

Ischemia and reperfusion injury (IRI) is an inevitable event in conventional organ transplant procedure and is associated with significant mortality and morbidity post-transplantation. We hypothesize that IRI is avoidable if the blood supply for the organ is not stopped, thus resulting in optimal transplant outcomes. Here we described the first case of a novel procedure called ischemia-free organ transplantation (IFOT) for patients with end-stage liver disease. The liver graft with severe macrovesicular steatosis was donated from a 25-year-old man. The recipient was a 51-year-old man with decompensated liver cirrhosis and hepatocellular carcinoma. The graft was procured, preserved, and implanted under continuous normothermic machine perfusion. The recipient did not suffer post-reperfusion syndrome or vasoplegia after revascularization of the allograft. The liver function test and histological study revealed minimal hepatocyte, biliary epithelium and vascular endothelium injury during preservation and post-transplantation. The inflammatory cytokine levels were much lower in IFOT than those in conventional procedure. Key pathways involved in IRI were not activated after allograft revascularization. No rejection, or vascular or biliary complications occurred. The patient was discharged on day 18 post-transplantation. This marks the first case of IFOT in humans, offering opportunities to optimize transplant outcomes and maximize donor organ utilization.

KEYWORDS:

clinical research/practice; liver allograft function/dysfunction; liver transplantation/hepatology; organ perfusion and preservation; organ procurement; surgical technique; translational research/science

PMID:
29127685
DOI:
10.1111/ajt.14583
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