Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definit...Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definition of PRS has evolved over the years,from changes in arterial blood pressures and heart and/or de-creases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS.However,all that did not reflect on the management of PRS or its impact on the outcomes.In recent years,new scientific techniques and new technology have been in the pipeline to better understand,manage and maybe prevent PRS.These new methods and techniques are still in the infancy,and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes.In this article,we will review the long history of PRS,its definition,etiology,mana-gement and most importantly the new advances in science and technology to prevent and properly manage PRS.展开更多
BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive...BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive strategy to expand the donor pool and reduce waitlist times.Given increased risk of cold ischemia time with SLT,machine perfusion represents a promising option to reduce it and optimize transplant logistics and outcomes.The present communication describes various possible combinations of procurement steps to perform SLT facilitated by placing one or both grafts on a normothermic machine perfusion(NMP)closed circuit device.CASE SUMMARY A 19-month-old female with biliary atresia after failed Kasai portoenterostomy and a 42-year-old woman with unresectable intrahepatic cholangiocarcinoma were selected as recipients for a SLT from a 17-year-old male donor.The SLT generated a left lateral segment and a right trisectional graft of appropriate volume for both recipients.After a mixed in-situ and ex-situ split,in order to improve logistics,the right trisectional graft was placed on a closed circuit NMP device,following an appropriate vascular reconstruction.Both grafts were implanted with excellent short-term outcomes.CONCLUSION Use of NMP with SLT for preservation prior to implantation allows not only for graft optimization but also for significant improvement of transplant logistics.We propose various models and standardization of logistic options for combining SLT with NMP to optimize graft availability and outcomes.展开更多
BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury...BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.展开更多
Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is s...Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is sensitive to pulmonary ventilation,it is also sensitive to physiological activities such as blood flow and cardiomotility,in addition,body movement/posture.This paper explores the possibility of simultaneously monitoring pulmonary ventilation,blood circulation and cardiomotility by bioimpedance measurement.Respiratory,blood perfusion and cardiomotility signals are extracted using the wavelet method from thoracic impedance data measured in breath-holding and tidal breathing statuses,to investigate signal strength and their dependency.This research provides a foundation for the development of bedside devices to monitor various physiological activities.展开更多
Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA...Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA visualizes the vascular network,revealing ischemia and reperfusion patterns in retinal vascular diseases.It has become a primary tool for assessing changes in the multilayer microvascular structure of the retina,applicable in conditions such as diabetic retinopathy,age-related macular degeneration,central serous chorioretinopathy,vascular occlusions,and glaucomatous optic neuropathy,among others.Moreover,OCTA is useful in the assessment of central nervous system diseases and is increasingly utilized in routine health examinations and scientific research.Its main advantages include high resolution,rapid,non-invasive scanning,and the ability to analyze microcirculation by observing different vascular layers through tomographic imaging.However,its sensitivity to blood flow velocity and susceptibility to artifacts,such as slow blood flow appearing as non-perfusion,are notable limitations.Overall,OCTA provides a visually intuitive approach for observing retinal blood flow and has significant clinical implications for ocular conditions.展开更多
The recent editorial by Parente et al provides a balanced overview of machine perfusion(MP)in liver transplantation.While its potential to improve graft pre-servation is clear,several challenges hinder routine adoptio...The recent editorial by Parente et al provides a balanced overview of machine perfusion(MP)in liver transplantation.While its potential to improve graft pre-servation is clear,several challenges hinder routine adoption:High costs,logisti-cal complexity,lack of standardized viability criteria,limited long-term outcome data,and absence of direct comparisons between hypothermic and normothermic MP.From my experience of over 900 liver transplants without MP,and the limi-ted uptake among Korean centers,compelling evidence for its necessity remains lacking.The immunomodulatory effects of MP,particularly in ABO-incompatible or sensitized recipients,remain underexplored.Future research should integrate immune profiling,mechanistic analyses,and biomarker-guided immunosup-pression strategies into multicenter trials to clarify its role in tolerance induction and long-term graft protection.Ethical,regulatory,and policy considerations especially in resource-limited settings must also be addressed to ensure equitable access.Robust clinical and mechanistic data are essential before MP can be fully endorsed as standard care.展开更多
BACKGROUND Anxiety is a common comorbidity in patients with Crohn’s disease(CD).Data on the imaging characteristics of brain microstructure and cerebral perfusion in CD with anxiety are limited.AIM To compare the ima...BACKGROUND Anxiety is a common comorbidity in patients with Crohn’s disease(CD).Data on the imaging characteristics of brain microstructure and cerebral perfusion in CD with anxiety are limited.AIM To compare the imaging characteristics of brain microstructure and cerebral perfusion among CD patients with or without anxiety and healthy individuals.METHODS This prospective comparative study enrolled consecutive patients with active CD and healthy individuals who visited the study hospital between January 2022 and January 2023.Anxiety was measured using the Hospital Anxiety and Depression Scale-Anxiety.The imaging characteristics of brain microstructure and cerebral perfusion were measured by diffusion kurtosis imaging and intravoxel incoherent motion.RESULTSA total of 57 participants were enrolled. Among the patients with active CD, 16 had anxiety. Compared withhealthy individuals, patients with active CD demonstrated significantly lower radial kurtosis values in the rightcerebellar region 6, lower axial kurtosis (AK) values in the right insula, left superior temporal gyrus, and rightthalamus, and higher slow and fast apparent diffusion coefficients (ADCslow and ADCfast) in the bilateral frontal lobe,bilateral temporal lobe, and bilateral insular lobe (all P < 0.05). Compared with patients with CD without anxiety,patients with CD and anxiety exhibited significantly higher ADCslow values in the left insular lobe and lower AKvalues in the right insula and right anterior cuneus (all P < 0.05).CONCLUSIONThere are variations in brain microstructure and perfusion among CD patients with/without anxiety and healthyindividuals, suggesting potential use in assessing anxiety-related changes in active CD.展开更多
BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case repor...BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver.The allocated liver from a 49-year-old female donor(161 cm,70 kg)was perfused with the OrganOx®normothermic machine perfusion system in the recommended way.Organ quality assessment was performed based on laboratory values at defined time points.In addition,the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment.After discarding the organ,biopsies were taken from each segment and correlated with the results of the HSI.CASE SUMMARY The donor liver’s size(29 cm×17 cm×11 cm)and weight of 2180 g posed challenges for adequate placement within the organ container.Baseline biopsy of the liver revealed no evidence of fibrosis,steatosis or inflammation.An hour after perfusion start,measurements of the perfusate indicated a pH of 7.18,a glucose level of 404 mg/dL,and a lactate level of 1.7 mmol/L.Throughout perfusion,a significant decline in glucose levels began at the fourth hour,reaching a nadir of 20 mg/dL after eight hours.Concurrently,lactate levels steadily rose,peaking at 4.9 mmol/L after the total perfusion time of 12 hours.Macroscopic alterations(signs of congestion and reduced blood circulation)on the liver’s surface were noted,particularly pronounced in segments 2,3,and 8.HSI of these areas unveiled significant reduced oxygenation.Consequently,based on all these observations,the decision was made to discard the organ.Histological examination of the altered regions revealed congestion,necrotic changes,and dissociation of CONCLUSION This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver.HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free ant...BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.展开更多
BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult...BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.展开更多
BACKGROUND Normothermic machine perfusion(NMP)utilizing OCS Liver is becoming increasingly common in adult liver transplantation(LT),but not in pediatric transplantation.OCS Liver has been shown to decrease post-reper...BACKGROUND Normothermic machine perfusion(NMP)utilizing OCS Liver is becoming increasingly common in adult liver transplantation(LT),but not in pediatric transplantation.OCS Liver has been shown to decrease post-reperfusion syndrome and early allograft dysfunction after transplantation.We describe the first case series of three pediatric patients who received a liver transplant using livers CASE SUMMARY Three pediatric patients,all with different etiologies of liver disease,were successfully transplanted with livers preserved with NMP.All patients are currently doing well with follow-ups of 7 to 16 months post-transplant.CONCLUSION The use of OCS Liver in pediatric LT is feasible and can be performed even in the sickest recipients with excellent outcomes.Utilization of OCS Liver can optimize donor and recipient factors to allow for optimal outcomes.展开更多
BACKGROUND Anoxic brain injury is a potentially lethal condition characterized by cerebral hypoperfusion and irreversible neuronal injury.Arterial spin-labeling(ASL)perfusion and diffusion-weighted imaging(DWI)magneti...BACKGROUND Anoxic brain injury is a potentially lethal condition characterized by cerebral hypoperfusion and irreversible neuronal injury.Arterial spin-labeling(ASL)perfusion and diffusion-weighted imaging(DWI)magnetic resonance imaging(MRI)have been proposed as tools to detect cerebral ischemic changes and may aid in the assessment of anoxic injury.AIM To explore the relationship between regional ASL perfusion patterns and clinical outcomes following cardiac arrest.METHODS We performed a retrospective review to identify patients with clinical suspicion of anoxic brain injury who underwent MRI within 15 days of cardiac arrest.Receiver operator characteristic(ROC)analysis and univariate logistic regression were used to evaluate associations between ASL perfusion scores,DWI signal intensity,and the following clinical features:(1)Myoclonus status epilepticus(MSE)within 24 hours;(2)Absent extensor or motor reflexes(EMR)at day 3 post-arrest;and(3)Absent brainstem reflexes(BSR)within 15 days.RESULTS Twenty-eight patients met inclusion criteria.Increased ASL signal in the left occipital lobe was significantly associated with MSE(P=0.038),while a trend was observed between right frontal ASL signal and EMR(P=0.078).ROC analysis showed that ASL scores≥7 were associated with higher odds of absent BSR(OR 2.14,P=0.53),though this did not reach statistical significance.DWI signal intensity did not show significant associations with clinical outcomes.The overall discriminatory performance of ASL for predicting outcomes was limited(AUC≈0.52).CONCLUSION This exploratory study suggests that regional ASL hyperperfusion,particularly in the left occipital and right frontal lobes,may be associated with adverse clinical signs following cardiac arrest.However,most findings did not reach statistical significance,and the study was underpowered to detect small-to-moderate effects.These preliminary results should be interpreted with caution and considered hypothesis-generating.Larger,prospective studies are warranted to clarify the prognostic value of ASL perfusion imaging in anoxic brain injury.展开更多
Background:The aim of the study was to explore a feasible method for alleviating limb ischemia-reperfusion injury(LI/RI)through the use of a high-concentration citrate solution(HC-A solution)for limb perfusion(LP).Met...Background:The aim of the study was to explore a feasible method for alleviating limb ischemia-reperfusion injury(LI/RI)through the use of a high-concentration citrate solution(HC-A solution)for limb perfusion(LP).Methods:Eighteen pigs were divided into three groups:the Sham group,LI/RI group,and HCA group.The Sham group underwent exposure of the iliac artery and vein.The LI/RI group underwent tourniquet placement and clamping of the iliac artery and vein to simulate LI/RI.The HCA group received HC-A solution LP for 30 min through the left iliac artery below the level of blood flow occlusion based on the LI/RI group.Oxidative stress markers and inflammatory response markers were compared among the three groups.Results:Compared to the LI/RI group,the HCA group showed significantly lower levels of serum creatine kinase(CK),lactate dehydrogenase(LDH),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),aspartate aminotransferase(AST),and ala-nine aminotransferase(ALT),and significantly greater activities of serum superoxide dismutase(SOD)(p<0.05).There were no significant differences in serum interleukin-6(IL-6)or in muscle MDA,SOD,TNF-α,and IL-6 between the HCA group and the LI/RI group(p>0.05).Compared to the LI/RI group,MDA,TNF-α,and IL-6 levels in the liver were significantly lower in the HCA group(p<0.05),while SOD activities were not significantly different(p>0.05).Histopathological examination revealed reduced skeletal muscle and liver damage in the HCA group compared to the LI/RI group.Conclusions:HC-A solution LP can alleviate liver damage caused by LI/RI in pigs.展开更多
Background:The use of grafts from donation after circulatory death(DCD)overcomes the inadequate donor organ supply.Our team developed a transportable dual hypothermic oxygenated machine perfusion(DHOPE)device,which in...Background:The use of grafts from donation after circulatory death(DCD)overcomes the inadequate donor organ supply.Our team developed a transportable dual hypothermic oxygenated machine perfusion(DHOPE)device,which initiates DHOPE at a recipient center to reduce static cold storage(SCS)time and the risk of graft failure in DCD liver transplantation.Methods:Six porcine livers per group with 30 min of warm ischemia exposure were preserved via SCS or DHOPE for 6 h and then reperfused for 12 h with whole blood to mimic transplantation.Hepatocellular and biliary function and injury were assessed in perfusate and bile samples.Molecular biomarkers and histology were compared between groups.Results:Reperfusion portal vein pressure,in a flow-constant manner,and alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and gamma-glutamyltransferase(γ-GGT)release were significantly lower in the DHOPE group than in the SCS group at all time points.Higher bile production paralleled the lower levels of ALP andγ-GGT in the DHOPE group.The DHOPE group secreted more total bilirubin(TBIL)in bile,resulting in decreased TBIL in the perfusate,and livers preserved with DHOPE exhibited better cholangiocellular function.Furthermore,improvements in hypoxia,the inflammatory response,cell-free microRNAs and energy metabolism were observed in the DHOPE group.There were fewer apoptotic cells and TGF-β1-positive cells in the liver parenchyma and extrahepatic bile duct in the DHOPE group than in the SCS group.Conclusions:This study demonstrates the efficacy of local 4℃DHOPE to protect porcine liver grafts from30-min warm ischemia damage.展开更多
Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incu...Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incurs high costs and potential immune responses in rat models.In our preliminary research,donor lungs perfused with Steen's solution exhibited significant lung injury post transplantation,likely due to a strong immune response elicited by the high concentration of xenogenic proteins upon reperfusion.This study explores a low-cost and efficient perfusate composition for use in rat EVLP and lung transplant models.The modified perfusate employed in this study uses artificial colloids as the primary component,with an albumin concentration of only 2%,demonstrating comparable physiological parameters,metabolic levels,and pathological changes to those of Steen's solution during EVLP.Moreover,the modified composition exhibited good biocompatibility in transplantation,with minimal lung injury.In summary,the proposed perfusate offers a safer and more economical alternative for establishing rat EVLP and lung transplant models,facilitating the advancement of related research.展开更多
文摘Post-reperfusion syndrome(PRS)in liver transplant recipients remains one of the most dreaded complications in liver transplant surgery.PRS can impact the short-term and long-term patient and graft outcomes.The definition of PRS has evolved over the years,from changes in arterial blood pressures and heart and/or de-creases in the systemic vascular resistance and cardiac output to including the fibrinolysis and grading the severity of PRS.However,all that did not reflect on the management of PRS or its impact on the outcomes.In recent years,new scientific techniques and new technology have been in the pipeline to better understand,manage and maybe prevent PRS.These new methods and techniques are still in the infancy,and they have to be proven not in prevention and management of PRS but their effects in the patient and graft outcomes.In this article,we will review the long history of PRS,its definition,etiology,mana-gement and most importantly the new advances in science and technology to prevent and properly manage PRS.
文摘BACKGROUND Liver transplantation(LT)is the only curative,life-saving option for children and adults with end-stage liver disease.Due to the well-known shortage and heterogeneity of grafts,split LT(SLT)is an attractive strategy to expand the donor pool and reduce waitlist times.Given increased risk of cold ischemia time with SLT,machine perfusion represents a promising option to reduce it and optimize transplant logistics and outcomes.The present communication describes various possible combinations of procurement steps to perform SLT facilitated by placing one or both grafts on a normothermic machine perfusion(NMP)closed circuit device.CASE SUMMARY A 19-month-old female with biliary atresia after failed Kasai portoenterostomy and a 42-year-old woman with unresectable intrahepatic cholangiocarcinoma were selected as recipients for a SLT from a 17-year-old male donor.The SLT generated a left lateral segment and a right trisectional graft of appropriate volume for both recipients.After a mixed in-situ and ex-situ split,in order to improve logistics,the right trisectional graft was placed on a closed circuit NMP device,following an appropriate vascular reconstruction.Both grafts were implanted with excellent short-term outcomes.CONCLUSION Use of NMP with SLT for preservation prior to implantation allows not only for graft optimization but also for significant improvement of transplant logistics.We propose various models and standardization of logistic options for combining SLT with NMP to optimize graft availability and outcomes.
文摘BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.
基金the National Natural Science Foundation of China(No.61371017)the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2021QN37)。
文摘Impedance pneumography has a significant advantage for continuous and noninvasive monitoring of respiration,compared with conventional flowmeter-based ventilation measurement technologies.While thoracic impedance is sensitive to pulmonary ventilation,it is also sensitive to physiological activities such as blood flow and cardiomotility,in addition,body movement/posture.This paper explores the possibility of simultaneously monitoring pulmonary ventilation,blood circulation and cardiomotility by bioimpedance measurement.Respiratory,blood perfusion and cardiomotility signals are extracted using the wavelet method from thoracic impedance data measured in breath-holding and tidal breathing statuses,to investigate signal strength and their dependency.This research provides a foundation for the development of bedside devices to monitor various physiological activities.
文摘Optical coherence tomography angiography(OCTA)is a non-invasive imaging technique that analyzes the microvascular system of the eye.By capturing high-speed,repeated scans to detect the movement of red blood cells,OCTA visualizes the vascular network,revealing ischemia and reperfusion patterns in retinal vascular diseases.It has become a primary tool for assessing changes in the multilayer microvascular structure of the retina,applicable in conditions such as diabetic retinopathy,age-related macular degeneration,central serous chorioretinopathy,vascular occlusions,and glaucomatous optic neuropathy,among others.Moreover,OCTA is useful in the assessment of central nervous system diseases and is increasingly utilized in routine health examinations and scientific research.Its main advantages include high resolution,rapid,non-invasive scanning,and the ability to analyze microcirculation by observing different vascular layers through tomographic imaging.However,its sensitivity to blood flow velocity and susceptibility to artifacts,such as slow blood flow appearing as non-perfusion,are notable limitations.Overall,OCTA provides a visually intuitive approach for observing retinal blood flow and has significant clinical implications for ocular conditions.
文摘The recent editorial by Parente et al provides a balanced overview of machine perfusion(MP)in liver transplantation.While its potential to improve graft pre-servation is clear,several challenges hinder routine adoption:High costs,logisti-cal complexity,lack of standardized viability criteria,limited long-term outcome data,and absence of direct comparisons between hypothermic and normothermic MP.From my experience of over 900 liver transplants without MP,and the limi-ted uptake among Korean centers,compelling evidence for its necessity remains lacking.The immunomodulatory effects of MP,particularly in ABO-incompatible or sensitized recipients,remain underexplored.Future research should integrate immune profiling,mechanistic analyses,and biomarker-guided immunosup-pression strategies into multicenter trials to clarify its role in tolerance induction and long-term graft protection.Ethical,regulatory,and policy considerations especially in resource-limited settings must also be addressed to ensure equitable access.Robust clinical and mechanistic data are essential before MP can be fully endorsed as standard care.
基金Ethics Committee of Affiliated Changzhou Second People’s Hospital of Nanjing Medical University(approval number KY039-01).
文摘BACKGROUND Anxiety is a common comorbidity in patients with Crohn’s disease(CD).Data on the imaging characteristics of brain microstructure and cerebral perfusion in CD with anxiety are limited.AIM To compare the imaging characteristics of brain microstructure and cerebral perfusion among CD patients with or without anxiety and healthy individuals.METHODS This prospective comparative study enrolled consecutive patients with active CD and healthy individuals who visited the study hospital between January 2022 and January 2023.Anxiety was measured using the Hospital Anxiety and Depression Scale-Anxiety.The imaging characteristics of brain microstructure and cerebral perfusion were measured by diffusion kurtosis imaging and intravoxel incoherent motion.RESULTSA total of 57 participants were enrolled. Among the patients with active CD, 16 had anxiety. Compared withhealthy individuals, patients with active CD demonstrated significantly lower radial kurtosis values in the rightcerebellar region 6, lower axial kurtosis (AK) values in the right insula, left superior temporal gyrus, and rightthalamus, and higher slow and fast apparent diffusion coefficients (ADCslow and ADCfast) in the bilateral frontal lobe,bilateral temporal lobe, and bilateral insular lobe (all P < 0.05). Compared with patients with CD without anxiety,patients with CD and anxiety exhibited significantly higher ADCslow values in the left insular lobe and lower AKvalues in the right insula and right anterior cuneus (all P < 0.05).CONCLUSIONThere are variations in brain microstructure and perfusion among CD patients with/without anxiety and healthyindividuals, suggesting potential use in assessing anxiety-related changes in active CD.
文摘BACKGROUND Hyperspectral imaging(HSI)offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs.Up to now,there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver.The allocated liver from a 49-year-old female donor(161 cm,70 kg)was perfused with the OrganOx®normothermic machine perfusion system in the recommended way.Organ quality assessment was performed based on laboratory values at defined time points.In addition,the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment.After discarding the organ,biopsies were taken from each segment and correlated with the results of the HSI.CASE SUMMARY The donor liver’s size(29 cm×17 cm×11 cm)and weight of 2180 g posed challenges for adequate placement within the organ container.Baseline biopsy of the liver revealed no evidence of fibrosis,steatosis or inflammation.An hour after perfusion start,measurements of the perfusate indicated a pH of 7.18,a glucose level of 404 mg/dL,and a lactate level of 1.7 mmol/L.Throughout perfusion,a significant decline in glucose levels began at the fourth hour,reaching a nadir of 20 mg/dL after eight hours.Concurrently,lactate levels steadily rose,peaking at 4.9 mmol/L after the total perfusion time of 12 hours.Macroscopic alterations(signs of congestion and reduced blood circulation)on the liver’s surface were noted,particularly pronounced in segments 2,3,and 8.HSI of these areas unveiled significant reduced oxygenation.Consequently,based on all these observations,the decision was made to discard the organ.Histological examination of the altered regions revealed congestion,necrotic changes,and dissociation of CONCLUSION This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver.HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.
文摘BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
文摘BACKGROUND Normothermic liver machine perfusion(NMP)is a novel technology used to preserve and evaluate the function of liver allografts.AIM To assess NMP utilization in liver transplant(LT)practices.METHODS All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed.Outcomes including discard rates,survival,preservation time and timing of surgery were compared between two groups:NMP vs non-NMP.RESULTS Between 2021 and 2023,NMP was utilized in 1493(6.3%)of all LTs in the United States.Compared to non-NMP group,NMP group had lower allograft discard rate(6.5%vs 10%,P<0.001),older recipients’age(median:47 vs 42 years,P<0.001),and higher utilization of donors from donation after circulatory death(DCD)(55%vs 11%,P<0.001).NMP group also had longer distances between recipient and donor hospitals(median:156 vs 138 miles,P<0.001),longer preser-vation time(median:12.2 vs 5.8 hours,P<0.001),and more daytime reperfusion(74%vs 55%,P<0.001).Post-transplant survival outcomes were comparable between the two groups.In a subgroup analysis of NMP,recipients in the long preservation time(≥8 hours)group had higher daytime reperfusion(78%vs 55%,P<0.001)and similar post-transplant survival when compared to the short preservation time(<8 hours)group.CONCLUSION The utilization of NMP is associated with lower discard rates and increased DCD organs for LT.NMP allows for prolonging the preservation time and increased occurrence of daytime LT,without any impact on the survival outcomes.
文摘BACKGROUND Normothermic machine perfusion(NMP)utilizing OCS Liver is becoming increasingly common in adult liver transplantation(LT),but not in pediatric transplantation.OCS Liver has been shown to decrease post-reperfusion syndrome and early allograft dysfunction after transplantation.We describe the first case series of three pediatric patients who received a liver transplant using livers CASE SUMMARY Three pediatric patients,all with different etiologies of liver disease,were successfully transplanted with livers preserved with NMP.All patients are currently doing well with follow-ups of 7 to 16 months post-transplant.CONCLUSION The use of OCS Liver in pediatric LT is feasible and can be performed even in the sickest recipients with excellent outcomes.Utilization of OCS Liver can optimize donor and recipient factors to allow for optimal outcomes.
文摘BACKGROUND Anoxic brain injury is a potentially lethal condition characterized by cerebral hypoperfusion and irreversible neuronal injury.Arterial spin-labeling(ASL)perfusion and diffusion-weighted imaging(DWI)magnetic resonance imaging(MRI)have been proposed as tools to detect cerebral ischemic changes and may aid in the assessment of anoxic injury.AIM To explore the relationship between regional ASL perfusion patterns and clinical outcomes following cardiac arrest.METHODS We performed a retrospective review to identify patients with clinical suspicion of anoxic brain injury who underwent MRI within 15 days of cardiac arrest.Receiver operator characteristic(ROC)analysis and univariate logistic regression were used to evaluate associations between ASL perfusion scores,DWI signal intensity,and the following clinical features:(1)Myoclonus status epilepticus(MSE)within 24 hours;(2)Absent extensor or motor reflexes(EMR)at day 3 post-arrest;and(3)Absent brainstem reflexes(BSR)within 15 days.RESULTS Twenty-eight patients met inclusion criteria.Increased ASL signal in the left occipital lobe was significantly associated with MSE(P=0.038),while a trend was observed between right frontal ASL signal and EMR(P=0.078).ROC analysis showed that ASL scores≥7 were associated with higher odds of absent BSR(OR 2.14,P=0.53),though this did not reach statistical significance.DWI signal intensity did not show significant associations with clinical outcomes.The overall discriminatory performance of ASL for predicting outcomes was limited(AUC≈0.52).CONCLUSION This exploratory study suggests that regional ASL hyperperfusion,particularly in the left occipital and right frontal lobes,may be associated with adverse clinical signs following cardiac arrest.However,most findings did not reach statistical significance,and the study was underpowered to detect small-to-moderate effects.These preliminary results should be interpreted with caution and considered hypothesis-generating.Larger,prospective studies are warranted to clarify the prognostic value of ASL perfusion imaging in anoxic brain injury.
基金Natural Science Foundation of Fujian Province,Grant/Award Number:2021J011262 and 2022J011095Youth Independent Innovation and Incubation Special Project,Grant/Award Number:2022QC07The project of 900th Hospital,Grant/Award Number:2021MS02 and 2023GK01。
文摘Background:The aim of the study was to explore a feasible method for alleviating limb ischemia-reperfusion injury(LI/RI)through the use of a high-concentration citrate solution(HC-A solution)for limb perfusion(LP).Methods:Eighteen pigs were divided into three groups:the Sham group,LI/RI group,and HCA group.The Sham group underwent exposure of the iliac artery and vein.The LI/RI group underwent tourniquet placement and clamping of the iliac artery and vein to simulate LI/RI.The HCA group received HC-A solution LP for 30 min through the left iliac artery below the level of blood flow occlusion based on the LI/RI group.Oxidative stress markers and inflammatory response markers were compared among the three groups.Results:Compared to the LI/RI group,the HCA group showed significantly lower levels of serum creatine kinase(CK),lactate dehydrogenase(LDH),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),aspartate aminotransferase(AST),and ala-nine aminotransferase(ALT),and significantly greater activities of serum superoxide dismutase(SOD)(p<0.05).There were no significant differences in serum interleukin-6(IL-6)or in muscle MDA,SOD,TNF-α,and IL-6 between the HCA group and the LI/RI group(p>0.05).Compared to the LI/RI group,MDA,TNF-α,and IL-6 levels in the liver were significantly lower in the HCA group(p<0.05),while SOD activities were not significantly different(p>0.05).Histopathological examination revealed reduced skeletal muscle and liver damage in the HCA group compared to the LI/RI group.Conclusions:HC-A solution LP can alleviate liver damage caused by LI/RI in pigs.
基金supported by grants from 2020 Guangdong Provincial and Municipal Joint Fund For Basic and Applied Basic Research Project(2020B1515120031)2020 Foshan Municipal Deng Fang Distinguished Research Program(2020A007)+2 种基金Key Scientific Research Program for the development of Ex vivo Liver Perfusion System of Foshan City,China[(2019)No.42]Science and Technol-ogy Program of Guangzhou(202002030201)Guangzhou Sci-ence and Technology Plan(2025A04J3674)。
文摘Background:The use of grafts from donation after circulatory death(DCD)overcomes the inadequate donor organ supply.Our team developed a transportable dual hypothermic oxygenated machine perfusion(DHOPE)device,which initiates DHOPE at a recipient center to reduce static cold storage(SCS)time and the risk of graft failure in DCD liver transplantation.Methods:Six porcine livers per group with 30 min of warm ischemia exposure were preserved via SCS or DHOPE for 6 h and then reperfused for 12 h with whole blood to mimic transplantation.Hepatocellular and biliary function and injury were assessed in perfusate and bile samples.Molecular biomarkers and histology were compared between groups.Results:Reperfusion portal vein pressure,in a flow-constant manner,and alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and gamma-glutamyltransferase(γ-GGT)release were significantly lower in the DHOPE group than in the SCS group at all time points.Higher bile production paralleled the lower levels of ALP andγ-GGT in the DHOPE group.The DHOPE group secreted more total bilirubin(TBIL)in bile,resulting in decreased TBIL in the perfusate,and livers preserved with DHOPE exhibited better cholangiocellular function.Furthermore,improvements in hypoxia,the inflammatory response,cell-free microRNAs and energy metabolism were observed in the DHOPE group.There were fewer apoptotic cells and TGF-β1-positive cells in the liver parenchyma and extrahepatic bile duct in the DHOPE group than in the SCS group.Conclusions:This study demonstrates the efficacy of local 4℃DHOPE to protect porcine liver grafts from30-min warm ischemia damage.
文摘Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion(EVLP),it incurs high costs and potential immune responses in rat models.In our preliminary research,donor lungs perfused with Steen's solution exhibited significant lung injury post transplantation,likely due to a strong immune response elicited by the high concentration of xenogenic proteins upon reperfusion.This study explores a low-cost and efficient perfusate composition for use in rat EVLP and lung transplant models.The modified perfusate employed in this study uses artificial colloids as the primary component,with an albumin concentration of only 2%,demonstrating comparable physiological parameters,metabolic levels,and pathological changes to those of Steen's solution during EVLP.Moreover,the modified composition exhibited good biocompatibility in transplantation,with minimal lung injury.In summary,the proposed perfusate offers a safer and more economical alternative for establishing rat EVLP and lung transplant models,facilitating the advancement of related research.
