Future Of Organ Preservation

Improving organ preservation by developing a new cold storage solution is a goal of many investigators. Currently, a common approach is to make minor changes in the UW solution and make a claim for an improved and different preservation. It may be difficult to dramatically improve organ preservation by simple cold storage and we may have reached the limits of safe storage (about 24 to 48 hours). The reason for this conclusion is based upon the organ's need for a source of energy to prevent tissue destruction. Energy must be constantly brought into the thermodynamically unstable tissues and cells; otherwise, membranes, cytoskeletal networks, cell-cell interactions, and various complex molecular structures break down. In cold ischemic storage there is no currently known method to maintain a satisfactory energetic state without continuous perfusion with perfu-sate or oxygen. The use of machine perfusion may be the method that could improve organ preservation. Improving the quality and longevity of heart preserva tion certainly may require continuous perfusion. In the heart, the lack of ATP leads to ischemic contracture due to the high concentration of contractile proteins. This ischemic contracture destroys the viability of the tissue. The liver can tolerate machine perfusion for 3 days and the kidney for 5 to 7 days. However, the arguments against using machine perfusion in a clinical setting are formidable. First, one-year graft survival in kidneys machine perfused or cold stored are about equal (about 90%). Second, machine perfusion is more expensive and requires a trained perfusionist. Third, most kidneys are now shared between centers that require some form of simple cold storage for shipment. Thus, without a clearly convincing rationale for machine perfusion, cold storage with short preservation times will probably continue to be used for most organs.

References

1. Pegg DE, Calne RY, Pryse-Davies J, Leigh-Brown F. Canine renal preservation using surface and perfusion cooling techniques. Ann NY Acad Sci 1964; 120:506-523.

2. Belzer FO, Ashby BS, Dumphy JE. 24- and 72- hour preservation of canine kidneys. Lancet 1967; 2:536-539.

3. Belzer FO, Ashby BS, Huang JS, Dumphy JE. Etiology of rising perfusion pressure in isolated organ perfusion. Ann Surg 1968; 168:382.

4. Belzer FO, Ashby BS, Gulyassy PF, Powell M. Successful seventeen-hour preservation and transplantation of human-cadaver kidney. N Engl J Med 1968; 278:608-610.

5. Booster MH, van der Vusse GJ, Wijnen RMH, Stubenitsky BM, Kootstra G, Yin M. University of Wisconsin solution is superior to histidine tryptophan ketoglu-tarate for preservation of ischemically damaged kidneys. Transplantation 1994; 58:979-983.

6. Light JA, Gage F, Kowalski AE, Sasaki TM, Callender CO. Immediate function and cost comparison between static and pulsatile preservation in kidney recipients. Clin Transplantation 1996; 10:233-236.

7. Collins GM, Bravo-Shugarman MB, Terasaki PI. Kidney preservation for transplantation: initial perfusion and 30 hour ice storage. Lancet 1969; 2:1219-1225.

8. Macknight ADC, Pilgrim JP, Robinson BA. The regulation of cellular volume in liver slices. J Physiol 1974; 238:279-294.

9. Jamieson NV, Sundberg R, Lindell S, Southard JH, Belzer FO. Preservation of the canine liver for 24-48 hours using simple cold storage with UW solution. Transplantation 1988; 46:517-525.

10. Wahlberg JA, Love R, Landegaard L, Southard JH, Belzer FO. 72-hour preservation of the canine pancreas. Transplantation 1987; 43:5-8.

11. Ploeg RJ, Goossens D, NcAnulty JF, Southard JH, Belzer FO. Successful 72-hour cold storage of dog kidneys with UW solution. Transplantation 1988; 46:191-196.

12. Jeevanandam V, Barr ML, Auteri JS et al. University of Wisconsin solution for human donor heart preservation: Initial clinical experience. Ann Thorac Surg 1991; 52:1213-1216.

13. Hardesty RL, Aeba R, Armitage JM, Kormes RL, Griffith BP. A clinical trial of University of Wisconsin solution for pulmonary preservation. J Thorac Cardiovasc Surg 1993; 105:660-666.

Barber WH, Deierhoi MH, Phillips MG, Diethelm AG. Preservation by pulsatile perfusion improves early renal allograft function. Transplant Proc 1988; 20:865-868.

McAnulty JF, Ploeg RJ, Southard JH, Belzer FO. Successful five-day perfusion preservation of the canine kidney. Transplantation 1989; 47:37-41. Schilling M, Saunder A, Southard JH, Belzer FO. Long-term renal preservation and prevention of acute tubular necrosis by inhibition of arachidonate metabolism. Transplant Proc 1993; 25:2534-2535.

Pienaar BH, Lindell SL, van Gulik TM, Southard JH, Belzer FO. Seventy-two-hour preservation of the canine liver by machine perfusion. Transplantation 1990; 49:258-260.

Fuller BJ. The effects of cooling on mammalian cells. In: Clinical applications of cryobiology. Fuller BJ, Grout BWW, eds. Boca Raton: CRC Press, 1991; 1-22. Hoffmann RM, Stieper KW, Johnson RWG, Belzer FO. Renal ischemic tolerance. Arch Surg 1974; 109:550-552.

Bonventre JV, Weinberg JM. Kidney preservation ex vivo for transplantation. Ann Rev Med 1992; 43:523-553.

P, Harvey PRC, Strasberg SM. Preservation and reperfusion injuries in liver al-lografts. An overview and synthesis of current studies. Transplantation 1992; 53:957-978.

Anundi I, King J, Owen DA, Schneider H, Lemasters JJ, Thurman RG. Fructose prevents hypoxic cell death in liver. Am J Physiol 1987; G390-G396. Brass CA, Crawford JM, Narciso J, Gollan JL. Hypoxic liver injury and the ameliorating effects of fructose: The glucose paradox revisited. Am J Physiol 1992; 263:G293-G300.

Stringham JC, Southard JH, Hegge J, Triemstra L, Fields BL, Belzer FO. Limitations of heart preservation by cold storage. Transplantation 1992; 53:287-293. Pegg DE, Foreman J, Hunt CJ, Diaper MP. The mechanism of action of retrograde oxygen persulfflation in renal preservation. Transplantation 1989; 48:210-217.

Fujino Y, Kuroda Y, Suzuki Y et al. Preservation of canine pancreas for 96 hours by a modified two-layer (UW solution/perfluorochemical) cold storage method. Transplantation 1991; 51:1133-1135.

Kuroda Y, Fujino Y, Morita A, Tanioka Y, Ku Y, Saitoh Y. Oxygenation of the human pancreas during preservation by a two-layer (University of Wisconsin solution/perfluorochemical) cold storage method. Transplantation 1992; 54:561-562. Imberti R, Nieminen A, Herman B, Lemasters JJ. Mitochondrial and glycolytic dysfunction in lethal injury to hepatopcytes and t-butylhydroxide: Protection by fructose, cyclosporin A and trifluoperazine. J Pharmacol Exp Ther 1993; 265:392-400.

Clavien P, Sanabria JR, Upadhaya A, Harvey PRC, Strasberg SM. Evidence of the existence of a soluble mediator of cold preservation injury. Transplantation 1993; 56:44-53.

Sumimoto R, Kamada N. Lactobionate as the most important component in UW solution for liver preservation. Transplant Proc 1990; 22:2198-2199. Southard JH, van Gulik TM, Ametani MS et al. Important components of the UW solution. Transplantation 1990; 49:251-257.

Bulkley GB, Morris JB. Role of oxygen-derived free radicals as mediators of post-ischemic injury: A clinically oriented overview. In: Proceedings of the fourth international conference superoxide and SOD 1990; 1-7.

33. Land W, Messmer K. The impact of ischemia/reperfusion injury on specific and non-specific, early and late chronic events after organ transplantation. Transplant Rev 1996; 10:108-127.

34. Lemasters JJ, Bunzendahl H, Thurman RG. Reperfusion injury to donor livers stored for transplantation. Liver Transplant Surg 1995; 1:124-138.

35. Cosenza CA, Cramer DV, Cunneen SA, Tuso PJ, Wang HK, Makowka L. Protective effect of the lazaroid U74006F in cold ischemia-reperfusion injury of the liver. Hepatology 1994; 19:418-425.

36. Bromley PN, Cottam SJ, Hilmi I et al. Effects of intraoperative n-acetylcysteine in orthotopic liver transplantation. Br J Anaesth 1995; 75:352-354.

37. Rabl H, Khoschsorur G, Colombo T et al. A multivitamin infusion prevents lipid peroxidation and improves transplantation performance. Kid Intl 1993; 43:912-917.

38. Vreugdenhil PK, Belzer FO, Southard JH. Effect of cold storage on tissue and cellular glutathione. Cryobiology 1991; 28:143-149.

39. Marubayashi S, Dohi K, Sumimoto K, Sugino K, Ochi K, Kawasaki T. Role of free radicals in ischemic rat liver preservation: prevention of damage by vitamin E, CoQ, or reduced glutathione. Transplant Proc 1988; 20:974-975.

40. Kurose I, Granger DN. Evidence implicating xanthine oxidase and neutrophils in reperfusion-induced microvascular dysfunction. Ann N Y Acad Sci 1995; 158-179.

41. Boudjema K, van Gulik TM, Lindell SL, Vreugdenhil PK, Southard JH, Belzer FO. Effect of oxidized and reduced glutathione in liver preservation. Transplantation 1990; 50:948-951.

42. Sumimoto R, Jamieson NV, Fukuda T, Dohi K, Kamada N. The need for glu-tathione and allopurinol in HL solution for rat liver preservation. Transplantation 1991; 52:565-567.

43. Ametani MS, Southard JH, Belzer FO. Importance of glutathione and adenosine in cold storage of the kidney. Transplant Proc 1990; 22:469-471.

44. Jaeschke H. The therapeutic potential of glutathione in hepatic ischemia-reper-fusion injury. Transplantation 1993; 56:256-257.

45. Janssen M, Koster JF, Bos E, De Jong JW. Malondialdehyde and glutathione production in isolated perfused human and rat hearts. Circ Res 1993; 73:681-688.

46. Ferguson DM, Gores GJ, Bronk SF, Krom RAF. An increase in cytostolic protease activity during liver preservation. Inhibition by glutathione and glycine. Transplantation 1993; 55:627

47. Ferguson DM, Gores GJ, Ludwig J, Krom RAF. UW solution protects against reperfusion injury by inhibiting lipid peroxidation. Transplant Proc 1991; 23:1552-1553.

48. Jassem W, Ciarimboli C, Cerioni PN, Saba V, Norton SJ, Principato G. Glyoxalase II and glutathione levels in rat liver mitochondria during cold storage in Euro-Collins and University of Wisconsin Solutions. Transplantation 1996; 61:1416-1420.

49. Astier A, Paul M. Instability of reduced glutathione in commercial Belzer cold storage solution. Lancet 1989; 2:556.

50. Sumimoto R, Jamieson NV, Wake K, Kamada N. 24-hour rat liver preservation using UW solution and some simplified variants. Transplantation 1989; 48:1-5.

51. Pietri S, Culcasi M, Albat B, Alberci G, Menasche P. Direct assessment of the antioxidant effects of a new heart preservation solution, Celsior. Transplantation 1994; 58:739-742.

Jamieson NV. A new solution for liver preservation. Br J Surg 1989; 76:107-108. Ploeg RJ, Boudjema K, Marsh D et al. Importance of a colloid in canine pancreas preservation. Transplantation 1992; 53:735-741.

Wicomb WN, Collins GM. 24-hour rabbit heart storage with UW solution: Effects of low-flow perfusion, colloid, and shelf storage. Transplantation 1989; 48:6-9.

Charrueau C, Blonde-Cynober F, Coudray-Lucas C et al. Aminoacids in a cold preservation solution inhibits proteolysis of rat livers and improves portal flow rate and bile production at reperfusion. Clin Nutr 1994; 13:35-43. Ko W, Zelano JA, Lazenby WD, Isom OW, Krieger KH. Compositional analysis of a modified University of Wisconsin solution for extended myocardial preservation. A study of the left ventricular pressure-volume relation. Circulation 1991; 86:II-326-II-332.

Howden BO, Jablonski P, Self G, Rosenfeldt F, Marshall VC. Effective organ preservation with modified HES-free UW solution with lowered potassium content. Transplant Proc 1992; 24:2274-2275.

Moen J, Claesson K, Pienaar BH et al. Preservation of dog liver, kidney, and pancreas using the Belzer-UW solution with a high-sodium and low-potassium content. Transplantation 1989; 47:940-945.

Cartier R, Dagenais F, Hollmann C, Carrier M, Pelletier LC. The role of preservation solutions in coronary endothelial damage during cold storage. Transplantation 1993; 56:997-1000.

Reitz B, Brady W, Hickey P. Protection of the heart for 24 hours with intracellu-lar (high K) solution and hypothermia. Surg Forum 1974; 25:149. Osswald H, Schmitz HJ, Kemper R. Tissue content of adenosine, inosine and hypoxanthine in the rat kidney after ischemia and postischemic recirculation. Pflugers Arch 1977; 371:45-49.

Southard JH, Belzer FO. The University of Wisconsin Organ Preservation Solution: Components, Comparisons, and Modifications. Transplantation Reviews 1993; 7:176-190.

Marzi I, Walcher F, Menger M, Buhren V, Harbauer G, Trentz O. Microcircula-tory disturbances and leukocyte adherence in transplanted livers after cold storage in Euro-Collins, UW and HTK solutions. Transplant Int 1991; 4:45-50. Ploeg RJ, D'Alessandro AM, Knechtle SJ et al. Risk factors for primary dysfunction after liver transplantation: A multivariate analysis. Transplantation 1993; 55:123-129.

Furukawa H, Todo S, Imventarza O et al. Effect of cold ischemia time on early outcome of human hepatic allografts preserved with UW solution. Transplantation 1991; 51:1000-1004.

Najarian JS, Gillingham KJ, Sutherland DER, Reinsmoen NL, Payne WD, Matas AJ. The impact of the quality of initial graft function on cadaver kidney transplants. Transplantation 1994; 57:812-816.

Opelz G, Wujciak T. Comparative analysis of kidney preservation methods. Transplant Proc 1996; 28:87-90.

Mozes MF, Finch WT, Reckard CR, Merkel FK, Cohen C. Comparison of cold storage and machine perfusion in the preservation of cadaver kidneys: A prospective, randomized study. Transplant Proc 1985; 17:1474-1477. Jaffers GJ, Banowsky LH. The absence of a deleterious effect of mechanical kidney preservation in the era of cyclosporine. Transplantation 1989; 47:734-736.

70. Henry ML, Sommer BG, Ferguson RM. Improved immediate function of renal allografts with Belzer perfusate. Transplantation 1988; 45(1):73-75.

71. Rosenthal JT, Danovitch GM, Wilkinson A, Ettenger RB. The high cost of delayed graft function in cadaveric renal transplantation. Transplantation 1991; 51:1115-1117.

72. Koyama H, Cecka JM, Terasaki PI. A comparison of cadaver donor kidney storage methods: Pump perfusion and cold storage solutions. Clin Transplant 1993; 7:199-205.

73. Ploeg RJ, Hajo van Bockel J, Langendijk PTH et al. Effect of preservation solution on results of cadaveric kidney transplantation. Lancet 1992; 340:129-137.

74. Todo S, Podesta L, Ueda Y et al. Comparison of UW with other solutions for liver preservation in dogs. Clin Transplant 1989; 3:253-259.

75. Najarian JS, Gillingham KJ, Sutherland DER, Reinsmoen NL, Payne WD, Matas AJ. The impact of the quality of initial graft function on cadaver kidney transplants. Transplantation 1994; 57:812-816.

76. Howard TK, Klintmalm GB, Cofer JB, Husberg BS, Goldstein RM, Gonwa TA. The influence of preservation injury on rejection in the hepatic transplant recipient. Transplantation 1990; 49:103-107.

77. Shackleton CR, Martin R, Melinek J et al. Lack of correlation between the magnitude of preservation injury and the incidence of acute rejection, need for OKT3, and conversion to FK506 in cyclosporine-treated primary liver allograft recipients. Transplantation 1995; 60:554-557.

0 0

Post a comment