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  Novel Real-Time Prediction of Liver Graft Function During Hypothermic Oxygenated Machine Perfusion Before Liver Transplantation

Muller, X., Schlegel, A., Kron, P., Eshmuminov, D., Würdinger, M., Meierhofer, D., et al. (2019). Novel Real-Time Prediction of Liver Graft Function During Hypothermic Oxygenated Machine Perfusion Before Liver Transplantation. Annals of Surgery, 270(5), 783-790. doi:10.1097/SLA.0000000000003513.

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Item Permalink: http://hdl.handle.net/21.11116/0000-0004-DA13-1 Version Permalink: http://hdl.handle.net/21.11116/0000-0005-1A47-F
Genre: Journal Article

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 Creators:
Muller, Xavier , Author
Schlegel, Andrea , Author
Kron, Philipp , Author
Eshmuminov, Dilmurod , Author
Würdinger, Michael , Author
Meierhofer, David1, Author              
Clavien, Pierre-Alain , Author
Dutkowski, Philipp , Author
Affiliations:
1Mass Spectrometry (Head: David Meierhofer), Scientific Service (Head: Christoph Krukenkamp), Max Planck Institute for Molecular Genetics, Max Planck Society, ou_1479669              

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Free keywords: complex I; FMN; hypothermic oxygenated perfusion; liver transplantation
 Abstract: OBJECTIVE: The aim of this study was to determine the predictive value of machine perfusate analysis on graft outcome. BACKGROUND: Ex situ machine perfusion (MP) is gaining increasing interest to potentially repair injured organs and to assess organ function. In the field of liver transplantation, however, no studies exist on reliable prediction of graft function during MP. METHODS: We have used hypothermic oxygenated perfusion (HOPE) for donation after circulatory death (DCD) or extended criteria donation after brain death (DBD) human liver grafts during the last 7 years. Our series includes 100 HOPE-treated liver-transplanted patients with an overall tumor-censored 5-year graft survival of 89%. We monitored 54 livers during HOPE in terms of fluorometric analysis of released mitochondrial flavin (flavin mononucleotide, FMN) in the machine perfusate. RESULTS: Real-time optical measurement of mitochondrial FMN release in machine perfusates of livers disclosed a strong correlation with lactate clearance and coagulation factors at day 1 and 2 after transplantation. Receiver-operating characteristic curve analysis revealed an area under the curve (AUROC) of 0.79 [95% confidence interval (CI), 0.62-0.97] for severe allograft dysfunction and for early graft loss (AUROC 0.93, 95% CI, 0.84-1.0). CONCLUSIONS: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.

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Language(s): eng - English
 Dates: 2019-10-072019-11
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.1097/SLA.0000000000003513
PMID: 31592808
 Degree: -

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Title: Annals of Surgery
  Abbreviation : ANN SURG
Source Genre: Journal
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Affiliations:
Publ. Info: Philadelphia : Lippincott, Williams & Wilkins (LWW) - an imprint of Wolters Kluwer
Pages: - Volume / Issue: 270 (5) Sequence Number: - Start / End Page: 783 - 790 Identifier: ISSN: 0003-4932 (print) 1528-1140 (online)