Current Status and Future Perspectives on Machine Perfusion: A Treatment Platform to Restore and Regenerate Injured Lungs Using Cell and Cytokine Adsorption Therapy

Since its advent in the 1990′s, ex vivo lung perfusion (EVLP) has been studied and implemented as a tool to evaluate the quality of a donor organ prior to transplantation. It provides an invaluable window of opportunity for therapeutic intervention to render marginal lungs viable for transplantation. This ultimately aligns with the need of the lung transplant field to increase the number of available donor organs given critical shortages. As transplantation is the only option for patients with end-stage lung disease, advancements in technology are needed to decrease wait-list time and mortality. This review summarizes the results from the application of EVLP as a therapeutic intervention and focuses on the use of the platform with regard to cell therapies, cell product therapies, and cytokine filtration among other technologies. This review will summarize both the clinical and translational science being conducted in these aspects and will highlight the opportunities for EVLP to be developed as a powerful tool to increase the donor lung supply.

Perioperatives Management der postmortalen Organspende

Zusammenfassung Hintergrund Die Anzahl postmortal gespendeter Organe ist in Deutschland weit geringer als der Bedarf. Dies unterstreicht die Wichtigkeit einer optimalen Versorgung während des gesamten Prozesses der Organspende. Fragestellung Es existieren internationale Leitlinien und nationale Empfehlungen zu intensivmedizinischen organprotektiven Maßnahmen beim Organspender. Für das anästhesiologische Management fehlen evidenzbasierte Empfehlungen. Ziel dieser Übersichtsarbeit ist es, anhand der vorhandenen Evidenz die pathophysiologischen Veränderungen des irreversiblen Hirnfunktionsausfalls zu rekapitulieren und sich kritisch mit den empfohlenen Behandlungsstrategien und therapeutischen Zielgrößen auseinanderzusetzen. Auch auf ethische Aspekte der Betreuung des postmortalen Organspenders wird eingegangen. Methode Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed (Suchwörter: „brain dead donor“, „organ procurement“, „organ protective therapy“, „donor preconditioning“, „perioperative donor management“, „ethical considerations of brain dead donor“). Internationale Leitlinien und nationale Empfehlungen wurden besonders berücksichtigt. Ergebnisse Insgesamt ist die Evidenz für optimale intensivmedizinische und perioperative organprotektive Maßnahmen beim postmortalen Organspender sehr gering. Nationale und internationale Empfehlungen zu Zielwerten und medikamentösen Behandlungsstrategien unterscheiden sich teilweise erheblich: kontrollierte randomisierte Studien fehlen. Der Stellenwert einer Narkose zur Explantation bleibt sowohl unter pathophysiologischen Gesichtspunkten als auch aus ethischer Sicht ungeklärt. Schlussfolgerungen Die Kenntnisse über die pathophysiologischen Prozesse im Rahmen des irreversiblen Hirnfunktionsausfalls und die organprotektiven Maßnahmen sind ebenso Grundvoraussetzung wie die ethische Auseinandersetzung mit dem Thema postmortale Organspende. Nur dann kann das Behandlungsteam in dieser herausfordernden Situation sowohl dem Organempfänger als auch dem Organspender und seinen Angehörigen gerecht werden.

PHENOMENON OF DEMIKHOV. At N.V. Sklifosovsky Institute (1960–1986). Paradigm shift in homologous organ transplantation: from overcoming biological incompatibility to artificial immunological tolerance (1960–1970)

The analysis of literature on experimental and clinical transplantation for the period of the 1968–1969 demonstrated that in the period from 1960 to 1970 the world transplantation saw a paradigm change in the field of homoorgan transplant: instead of overcoming the incompatibility between the donor organ and the recipient's body by using biological and physiological methods to influence the organ, which V.P. Demikhov had been dealing with for many years; surgeons and scientists, first abroad, and then in the USSR started developing and applying the creation of artificial immunological tolerance by using various physical, chemical and biological methods to impact recipient's body. The change of paradigms significantly influenced the implementation of organ transplantation techniques in clinic, including those of vital organs, and the further development of clinical transplantology. The data on the first heart transplants in 1968 and lung transplants in 1963–1970 have been presented.

Future of Solid Organ Transplantation: Organ-Specific Tolerance

A transplant between two people who are not genetically identical is called an allotransplant and the process is called allotransplantation. Donor organs and tissues can be from people who are living, or people who have died because of a significant brain injury or lack of circulation. Allotransplantation can create a rejection process where the immune system of the recipient attacks the foreign donor organ or tissue and destroys it. The recipient may need to take immunosuppressive medication for the rest of their life to reduce the risk of rejection of the donated organ. In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ transplant. The adverse effects associated with these agents and the risks of long-term immunosuppression present a number of challenges for the clinician. Immune tolerance, or immunological tolerance, or immunotolerance, is a state of unresponsiveness of the immune system to substances or tissue that have the capacity to elicit an immune response in a given organism.

Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer

Invasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients.