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2. What Is Hot and New in Basic and Translational Science in Liver Transplantation in 2023? Report of the Basic and Translational Research Committee of the International Liver Transplantation Society

Author

Bonaccorsi-Riani, Eliano, Ghinolfi, Davide, Czigany, Zoltan, Dondossola, Daniele, Emamaullee, Juliet, Yuksel, Muhammed, Boteon, Yuri L., Al-Adra, David, Ho, Cheng-Maw, Abdelrahim, Maen, Pang, Li, Barbas, Andrew, Meier, Raphael, MacParland, Sonya, Sayed, Blayne Amir, Pavan-Guimaraes, Juliana, Brüggenwirth, Isabel M.A., Zarrinpar, Ali, Mas, Valeria R., Selzner, Markus, Martins, Paulo N., and Bhat, Mamatha

Published
2024
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4. Discarded livers tested by normothermic machine perfusion in the VITTAL trial: Secondary end points and 5-year outcomes

Author

Mergental, Hynek, primary, Laing, Richard W., additional, Kirkham, Amanda J., additional, Clarke, George, additional, Boteon, Yuri L., additional, Barton, Darren, additional, Neil, Desley A.H., additional, Isaac, John R., additional, Roberts, Keith J., additional, Abradelo, Manuel, additional, Schlegel, Andrea, additional, Dasari, Bobby V.M., additional, Ferguson, James W., additional, Cilliers, Hentie, additional, Morris, Chris, additional, Friend, Peter J., additional, Yap, Christina, additional, Afford, Simon C., additional, Perera, M. Thamara P.R., additional, and Mirza, Darius F., additional

Published
2023
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5. Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation

Author

De Goeij, Femke H.C., primary, De Meijer, Vincent, additional, Mergental, Hynek, additional, Guarrera, James V., additional, Asthana, Sonal, additional, Ghinolfi, Davide, additional, Boteon, Yuri L., additional, Selzner, Nazia, additional, Kalisvaart, Marit, additional, Pulitano, Carlo, additional, Sonnenday, Christopher, additional, Martins, Paulo N., additional, Berlakovich, Gabriela, additional, and Schlegel, Andrea, additional

Published
2023
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10. Results of Liver Transplantation for Hepatocellular Carcinoma in a Multicenter Latin American Cohort Study

Author

Pinero, Federico, Costa, Paulo, Boteon, Yuri L., Duque, Sergio Hoyos, Marciano, Sebastian, Anders, Margarita, Varón, Adriana, Zerega, Alina, Poniachik, Jaime, Soza, Alejandro, Machaca, Martín Padilla, Menéndez, Josemaría, Zapata, Rodrigo, Vilatoba, Mario, Muñoz, Linda, Maraschio, Martín, Fauda, Martín, McCormack, Lucas, Gadano, Adrian, Boin, Ilka SF, García, Jose H. Parente, and Silva, Marcelo

Published
2018
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11. Transplantation of discarded livers following viability testing with normothermic machine perfusion

Author

Mergental, Hynek, Laing, Richard W., Kirkham, Amanda J., Perera, M. Thamara P. R., Boteon, Yuri L., Attard, Joseph, Barton, Darren, Curbishley, Stuart, Wilkhu, Manpreet, Neil, Desley A. H., Hübscher, Stefan G., Muiesan, Paolo, Isaac, John R., Roberts, Keith J., Abradelo, Manuel, Schlegel, Andrea, Ferguson, James, Cilliers, Hentie, Bion, Julian, Adams, David H., Morris, Chris, Friend, Peter J., Yap, Christina, Afford, Simon C., and Mirza, Darius F.

Published
2020
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13. Discarded livers tested by normothermic machine perfusion in the VITTAL trial: Secondary end points and 5-year outcomes.

Author

Mergental, Hynek, Laing, Richard W., Kirkham, Amanda J., Clarke, George, Boteon, Yuri L., Barton, Darren, Neil, Desley A. H., Isaac, John R., Roberts, Keith J., Abradelo, Manuel, Schlegel, Andrea, Dasari, Bobby V. M., Ferguson, James W., Cilliers, Hentie, Morris, Chris, Friend, Peter J., Yap, Christina, Afford, Simon C., Perera, M. Thamara P. R., and Mirza, Darius F.

Published
2024
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18. What Is Hot and New in Basic and Translational Science in Liver Transplantation in 2022? Report of the Basic and Translational Research Committee of the International Liver Transplantation Society

Author

Bhat, Mamatha, primary, Dondossola, Daniele, additional, Varghese, Rhea, additional, Czigany, Zoltan, additional, Emamaullee, Juliet, additional, Ghinolfi, Davide, additional, Al-Adra, David, additional, Bonaccorsi-Riani, Eliano, additional, Pang, Li, additional, Boteon, Yuri L., additional, Brüggenwirth, Isabel, additional, Pavan-Guimaraes, Juliana, additional, Ho, Cheng-Maw, additional, Yuksel, Muhammed, additional, Zarrinpar, Ali, additional, Abdelrahim, Maen, additional, Barbas, Andrew S., additional, Mas, Valeria, additional, Selzner, Markus, additional, and Martins, Paulo N., additional

Published
2022
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22. Eleven hours of hypothermic oxygenated machine perfusion (HOPE) for complex liver retransplantation: A case report.

Author

Boteon, Amanda P. C. S., Lima, Marisa R. D., Guardia, Bianca Della, Carvalho, Mauricio F., Schlegel, Andrea, and Boteon, Yuri L.

Subjects
PERFUSION, REPERFUSION, LIVER, SEALING devices, HOPE, LEWIS basicity
Abstract

Hypothermic oxygenated machine perfusion reduces early allograft injury and improves post-transplant outcomes in extended criteria donation liver transplantation from donation after brain death: results from a multicenter randomized controlled trial (HOPE ECD-DBD). Keywords: case report; hypothermic oxygenated machine perfusion; liver transplantation; machine perfusion EN case report hypothermic oxygenated machine perfusion liver transplantation machine perfusion 1413 1415 3 09/06/23 20230801 NES 230801 This case report describes the longest reported HOPE treatment ever for an extended criteria donor organ in donation after brain death performed to enable the transplantation of a surgically complex retransplant case. Customarily, only good quality donor organs are acceptable for these high-risk re-LT recipients because the organ needs to withstand longer CIT, and frequently the recipient cannot cope with a stormy postreperfusion syndrome as the hepatectomy phase is already associated with additional blood loss, longer operative time, and coexisting previous organ dysfunction. [Extracted from the article]

Published
2023
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23. The economic impact of machine perfusion technology in liver transplantation

Author

Boteon, Yuri L., primary, Hessheimer, Amelia J., additional, Brüggenwirth, Isabel M. A., additional, Boteon, Amanda P. C. S., additional, Padilla, María, additional, Meijer, Vincent E., additional, Domínguez‐Gil, Beatriz, additional, Porte, Robert J., additional, Perera, M. Thamara P. R., additional, and Martins, Paulo N., additional

Published
2021
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24. Introduction of the Concept of Diagnostic Sensitivity and Specificity of Normothermic Perfusion Protocols to Assess High‐Risk Donor Livers

Author

Mergental, Hynek, primary, Laing, Richard W., additional, Hodson, James, additional, Boteon, Yuri L., additional, Attard, Joseph A., additional, Walace, Laine L., additional, Neil, Desley A. H., additional, Barton, Darren, additional, Schlegel, Andrea, additional, Muiesan, Paolo, additional, Abradelo, Manuel, additional, Isaac, John R., additional, Roberts, Keith, additional, Perera, M. Thamara P. R., additional, Afford, Simon C., additional, and Mirza, Darius F., additional

Published
2021
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25. Machine perfusion organ preservation: Highlights from the American Transplant Congress 2022.

Author

Boteon, Yuri L., Angelico, Roberta, Buchholz, Bettina M., Dabare, Dilan, and Martins, Paulo N.

Subjects
*PRESERVATION of organs, tissues, etc., *MACHINE theory, *DIGITAL preservation, *TRANSPLANTATION of organs, tissues, etc., *PERFUSION, *CELLULAR therapy, *MACHINERY
Abstract

The American Transplant Congress 2022, which took place between June 4th and June 8th of 2022, was a hybrid meeting with in‐person attendance in Boston‐MA and a real‐time virtual experience via an online platform. First, we identified abstracts discussing machine perfusion preservation for all organs, a hot topic and approach that may develop into the new gold standard of organ preservation in the near future. A total of 39 abstracts on organ machine preservation were presented at the meeting. Next, we selected abstracts which focus on advances including new approaches to organ preservation, promising biomarkers, ex‐situ treatment including cellular therapies, and novel research areas. Here, we summarized the latest developments on machine perfusion preservation in both experimental and clinical studies. [ABSTRACT FROM AUTHOR]

Published
2023
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27. What Is Hot and New in Basic and Translational Science in Liver Transplantation in 2022? Report of the Basic and Translational Research Committee of the International Liver Transplantation Society

Author

Bhat, Mamatha, Dondossola, Daniele, Varghese, Rhea, Czigany, Zoltan, Emamaullee, Juliet, Ghinolfi, Davide, Al-Adra, David, Bonaccorsi-Riani, Eliano, Pang, Li, Boteon, Yuri L., Brüggenwirth, Isabel, Pavan-Guimaraes, Juliana, Ho, Cheng-Maw, Yuksel, Muhammed, Zarrinpar, Ali, Abdelrahim, Maen, Barbas, Andrew S., Mas, Valeria, Selzner, Markus, and Martins, Paulo N.

Published
2023
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30. Multicenter validation of the liver graft assessment following transplantation (L-GrAFT) score for assessment of early allograft dysfunction

Author

Agopian, Vatche G., primary, Markovic, Daniela, additional, Klintmalm, Goran B., additional, Saracino, Giovanna, additional, Chapman, William C., additional, Vachharajani, Neeta, additional, Florman, Sander S., additional, Tabrizian, Parissa, additional, Haydel, Brandy, additional, Nasralla, David, additional, Friend, Peter J., additional, Boteon, Yuri L., additional, Ploeg, Rutger, additional, Harlander-Locke, Michael P., additional, Xia, Victor, additional, DiNorcia, Joseph, additional, Kaldas, Fady M., additional, Yersiz, Hasan, additional, Farmer, Douglas G., additional, and Busuttil, Ronald W., additional

Published
2021
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32. The economic impact of machine perfusion technology in liver transplantation.

Author

Boteon, Yuri L., Hessheimer, Amelia J., Brüggenwirth, Isabel M. A., Boteon, Amanda P. C. S., Padilla, María, de Meijer, Vincent E., Domínguez‐Gil, Beatriz, Porte, Robert J., Perera, M. Thamara P. R., and Martins, Paulo N.

Subjects
*LIVER transplantation, *ECONOMIC impact, *PERFUSION, *ISOLATION perfusion, *LENGTH of stay in hospitals, *DISPOSABLE medical devices, *CLINICAL deterioration, *MACHINERY
Abstract

Introduction: Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine the costs related to machine perfusion and its associated outcomes. Methods: Expert opinion of several groups representing different machine perfusion modalities. Critical analysis of the published literature reporting the economic outcomes of the most used techniques of machine perfusion in liver transplantation (normothermic and hypothermic ex situ machine perfusion and in situ normothermic regional perfusion). Results: Machine perfusion costs include disposable components of the perfusion device, perfusate components, personnel and facility fees, and depreciation of the perfusion device or device lease fee. The limited current literature suggests that although this upfront cost varies between perfusion modalities, its use is highly likely to be cost‐effective. Optimization of the donor liver utilization rate, local conditions of transplant programs (long waiting list times and higher MELD scores), a decreased rate of complications, changes in logistics, and length of hospital stay are potential cost savings points that must highlight the expected benefits of this intervention. An additional unaccounted factor is that machine perfusion optimizing donor organ utilization allows patients to be transplanted earlier, avoiding clinical deterioration while on the waiting list and the costs associated with hospital admissions and other required procedures. Conclusion: So far, the clinical benefits have guided machine perfusion implementation in liver transplantation. Albeit there is data suggesting the economic benefit of the technique, further investigation of its costs to healthcare systems and society and associated outcomes is needed. [ABSTRACT FROM AUTHOR]

Published
2022
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33. The Delivery of Multipotent Adult Progenitor Cells to Extended Criteria Human Donor Livers Using Normothermic Machine Perfusion

Author

Laing, Richard W., primary, Stubblefield, Samantha, additional, Wallace, Lorraine, additional, Roobrouck, Valerie D., additional, Bhogal, Ricky H., additional, Schlegel, Andrea, additional, Boteon, Yuri L., additional, Reynolds, Gary M., additional, Ting, Anthony E., additional, Mirza, Darius F., additional, Newsome, Philip N., additional, Mergental, Hynek, additional, and Afford, Simon C., additional

Published
2020
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34. Correction: The impact on the bioenergetic status and oxidative-mediated tissue injury of a combined protocol of hypothermic and normothermic machine perfusion using an acellular haemoglobin-based oxygen carrier: The cold-to-warm machine perfusion of the liver

Author

Boteon, Yuri L., primary, Laing, Richard W., additional, Schlegel, Andrea, additional, Wallace, Lorraine, additional, Smith, Amanda, additional, Attard, Joseph, additional, Bhogal, Ricky H., additional, Reynolds, Gary, additional, Thamara PR Perera, M., additional, Muiesan, Paolo, additional, Mirza, Darius F., additional, Mergental, Hynek, additional, and Afford, Simon C., additional

Published
2020
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35. Manipulation of Lipid Metabolism During Normothermic Machine Perfusion: Effect of Defatting Therapies on Donor Liver Functional Recovery

Author

Boteon, Yuri L., Attard, Joseph, Boteon, Amanda P. C. S., Wallace, Lorraine, Reynolds, Gary, Hubscher, Stefan, Mirza, Darius F., Mergental, Hynek, Bhogal, Ricky H., and Afford, Simon C.

Subjects
Male, Living Donors, Humans, Nicotinamide Phosphoribosyltransferase, Perylene, Pretreatment Assessment and Conditions, Anthracenes, Phenylurea Compounds, Colforsin, Original Articles, Organ Preservation, Middle Aged, Allografts, Lipid Metabolism, Liver Transplantation, Fatty Liver, Perfusion, Butyrates, Pharmaceutical Solutions, Thiazoles, Liver, Reperfusion Injury, Tissue and Organ Harvesting, Feasibility Studies, Original Article, Female
Abstract

Strategies to increase the use of steatotic donor livers are required to tackle the mortality on the transplant waiting list. We aimed to test the efficacy of pharmacological enhancement of the lipid metabolism of human livers during ex situ normothermic machine perfusion to promote defatting and improve the functional recovery of the organs. Because of steatosis, 10 livers were discarded and were allocated either to a defatting group that had the perfusate supplemented with a combination of drugs to enhance lipid metabolism or to a control group that received perfusion fluid with vehicle only. Steatosis was assessed using tissue homogenate and histological analyses. Markers for lipid oxidation and solubilization, oxidative injury, inflammation, and biliary function were evaluated by enzyme‐linked immunosorbent assay, immunohistochemistry, and in‐gel protein detection. Treatment reduced tissue triglycerides by 38% and macrovesicular steatosis by 40% over 6 hours. This effect was driven by increased solubility of the triglycerides (P = 0.04), and mitochondrial oxidation as assessed by increased ketogenesis (P = 0.008) and adenosine triphosphate synthesis (P = 0.01) were associated with increased levels of the enzymes acyl‐coenzyme A oxidase 1, carnitine palmitoyltransferase 1A, and acetyl‐coenzyme A synthetase. Concomitantly, defatted livers exhibited enhanced metabolic functional parameters such as urea production (P = 0.03), lower vascular resistance, lower release of alanine aminotransferase (P = 0.049), and higher bile production (P = 0.008) with a higher bile pH (P = 0.03). The treatment down‐regulated the expression of markers for oxidative injury as well as activation of immune cells (CD14; CD11b) and reduced the release of inflammatory cytokines in the perfusate (tumor necrosis factor α; interleukin 1β). In conclusion, pharmacological enhancement of intracellular lipid metabolism during normothermic machine perfusion decreased the lipid content of human livers within 6 hours. It also improved the intracellular metabolic support to the organs, leading to successful functional recovery and decreased expression of markers of reperfusion injury.

Published
2018

36. The impact on the bioenergetic status and oxidative-mediated tissue injury of a combined protocol of hypothermic and normothermic machine perfusion using an acellular haemoglobin-based oxygen carrier: The cold-to-warm machine perfusion of the liver

Author

Boteon, Yuri L., primary, Laing, Richard W., additional, Schlegel, Andrea, additional, Wallace, Lorraine, additional, Smith, Amanda, additional, Attard, Joseph, additional, Bhogal, Ricky H., additional, Reynolds, Gary, additional, PR Perera, M. Thamara, additional, Muiesan, Paolo, additional, Mirza, Darius F., additional, Mergental, Hynek, additional, and Afford, Simon C., additional

Published
2019
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38. Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?

Author

Boteon, Amanda P. C. S., primary, Schlegel, Andrea, additional, Kalisvaart, Marit, additional, Boteon, Yuri L., additional, Abradelo, Manuel, additional, Mergental, Hynek, additional, Roberts, J. Keith, additional, Mirza, Darius F., additional, Perera, M. Thamara P. R., additional, Isaac, John R., additional, and Muiesan, Paolo, additional

Published
2019
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40. Viability testing and transplantation of marginal livers (VITTAL) using normothermic machine perfusion: study protocol for an open-label, non-randomised, prospective, single-arm trial

Author

Laing, Richard W, Mergental, Hynek, Yap, Christina, Kirkham, Amanda, Whilku, Manpreet, Barton, Darren, Curbishley, Stuart, Boteon, Yuri L, Neil, Desley A, Hübscher, Stefan G, Perera, M Thamara P R, Muiesan, Paolo, Isaac, John, Roberts, Keith J, Cilliers, Hentie, Afford, Simon C, and Mirza, Darius F

Subjects
Tissue Survival, Time Factors, Tissue and Organ Procurement, Non-Randomized Controlled Trials as Topic, Organ Preservation, hepatobiliary tumours, hepatobiliary disease, Transplant Recipients, Liver Transplantation, Perfusion, Liver, transplant surgery, hepatology, Practice Guidelines as Topic, Protocol, Feasibility Studies, Humans, Surgery, Prospective Studies
Abstract

Introduction The use of marginal or extended criteria donor livers is increasing. These organs carry a greater risk of initial dysfunction and early failure, as well as inferior long-term outcomes. As such, many are rejected due to a perceived risk of use and use varies widely between centres. Ex situ normothermic machine perfusion of the liver (NMP-L) may enable the safe transplantation of organs that meet defined objective criteria denoting their high-risk status and are currently being declined for use by all the UK transplant centres. Methods and analysis Viability testing and transplantation of marginal livers is an open-label, non-randomised, prospective, single-arm trial designed to determine whether currently unused donor livers can be salvaged and safely transplanted with equivalent outcomes in terms of patient survival. The procured rejected livers must meet predefined criteria that objectively denote their marginal condition. The liver is subjected to NMP-L following a period of static cold storage. Organs metabolising lactate to ≤2.5 mmol/L within 4 hours of the perfusion commencing in combination with two or more of the following parameters—bile production, metabolism of glucose, a hepatic arterial flow rate ≥150 mL/min and a portal venous flow rate ≥500 mL/min, a pH ≥7.30 and/or maintain a homogeneous perfusion—will be considered viable and transplanted into a suitable consented recipient. The coprimary outcome measures are the success rate of NMP-L to produce a transplantable organ and 90-day patient post-transplant survival. Ethics and dissemination The protocol was approved by the National Research Ethics Service (London—Dulwich Research Ethics Committee, 16/LO/1056), the Medicines and Healthcare Products Regulatory Agency and is endorsed by the National Health Service Blood and Transplant Research, Innovation and Novel Technologies Advisory Group. The findings of this trial will be disseminated through national and international presentations and peer-reviewed publications. Trial registration number NCT02740608; Pre-results.

Published
2017

41. Combined Hypothermic and Normothermic Machine Perfusion Improves Functional Recovery of Extended Criteria Donor Livers

Author

Boteon, Yuri L., primary, Laing, Richard W., additional, Schlegel, Andrea, additional, Wallace, Lorraine, additional, Smith, Amanda, additional, Attard, Joseph, additional, Bhogal, Ricky H., additional, Neil, Desley A. H., additional, Hübscher, Stefan, additional, Perera, M. Thamara P. R., additional, Mirza, Darius F., additional, Afford, Simon C., additional, and Mergental, Hynek, additional

Published
2018
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43. Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High‐Risk Livers Using Normothermic Machine Perfusion

Author

Mergental, Hynek, primary, Stephenson, Barnaby T. F., additional, Laing, Richard W., additional, Kirkham, Amanda J., additional, Neil, Desley A. H., additional, Wallace, Lorraine L., additional, Boteon, Yuri L., additional, Widmer, Jeannette, additional, Bhogal, Ricky H., additional, Perera, M. Thamara P. R., additional, Smith, Amanda, additional, Reynolds, Gary M., additional, Yap, Christina, additional, Hübscher, Stefan G., additional, Mirza, Darius F., additional, and Afford, Simon C., additional

Published
2018
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47. Assessment of liver graft quality during hypothermic oxygenated perfusion: the first international validation study.

Author

Eden J, Thorne AM, Bodewes SB, Patrono D, Roggio D, Breuer E, Lonati C, Dondossola D, Panayotova G, Boteon APCS, Walsh D, Carvalho MF, Schurink IJ, Ansari F, Kollmann D, Germinario G, Rivas Garrido EA, Benitez J, Rebolledo R, Cescon M, Ravaioli M, Berlakovich GA, De Jonge J, Uluk D, Lurje I, Lurje G, Boteon YL, Guarrera JV, Romagnoli R, Galkin A, Meierhofer D, Porte RJ, Clavien PA, Schlegel A, de Meijer VE, and Dutkowski P

Abstract

Background and Aim: While it is currently assumed that liver assessment is only possible during normothermic machine perfusion (NMP), there is uncertainty regarding a reliable and quick prediction of graft injury during ex situ hypothermic oxygenated perfusion (HOPE). We therefore intended to test, in an international liver transplant cohort, recently described mitochondrial injury biomarkers measured during HOPE before liver transplantation., Study Design: Perfusate samples of human livers from 10 centers in 7 countries with HOPE-experience were analyzed for released mitochondrial compounds, i.e. flavin mononucleotide (FMN), NADH, purine derivates and inflammatory markers. Perfusate FMN was correlated with graft loss due to primary non-function or symptomatic non-anastomotic biliary strictures (NAS), and kidney failure, as well as liver injury after transplantation. Livers deemed unsuitable for transplantation served as negative control., Results: We collected 473 perfusate samples of human DCD (n=315) and DBD livers (n=158). Fluorometric assessment of FMN in perfusate was validated by mass spectrometry (R=0.7011,p<0.0001). Graft loss due to primary non-function or cholangiopathy was predicted by perfusate FMN values (c-statistic mass spectrometry 0.8418 (95%CI 0.7466-0.9370,p<0.0001), c-statistic fluorometry 0.7733 (95%CI 0.7006-0.8461,p<0.0001). Perfusate FMN values were also significantly correlated with symptomatic NAS and kidney failure, and superior in prediction of graft loss when compared to conventional scores derived from donor and recipient parameters, such as the donor risk index and the balance of risk score. Mitochondrial FMN values in liver tissues of non-utilized livers were low, and inversely correlated to high perfusate FMN values and purine metabolite release., Conclusions: This first international study validates the predictive value of the mitochondrial co-factor FMN, released from complex I during HOPE, and may therefore contribute to a better risk stratification of injured livers before implantation., Impact and Implications: Analysis of 473 perfusates, collected from 10 international centers during hypothermic oxygenated perfusion (HOPE), revealed that mitochondria derived flavin mononucleotide (FMN) values in perfusate is predictive for graft loss, cholangiopathy, and kidney failure after liver transplantation. This result is of high clinical relevance, as recognition of graft quality is urgently needed to improve the safe utilization of marginal livers. Ex-situ machine perfusion approaches, such as HOPE, are therefore likely to increase the number of useable liver grafts., (Copyright © 2024. Published by Elsevier B.V.)

Published
2024
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48. Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond.

Author

Della Guardia B, Boteon APCS, Matielo CEL, Felga G, and Boteon YL

Subjects
Humans, Liver Cirrhosis diagnosis, Prognosis, Perfusion adverse effects, Acute-On-Chronic Liver Failure diagnosis, Acute-On-Chronic Liver Failure surgery, Liver Transplantation adverse effects
Abstract

Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in patients with chronic liver disease and is characterized by acute decompensation, organ failure and high short-term mortality. Partially due to the lack of universal diagnostic criteria, the actual ACLF prevalence remains unclear; nevertheless, it is expected to be a highly prevalent condition worldwide. Earlier transplantation is an effective protective measure for selected ACLF patients. Besides liver trans-plantation, diagnosing and treating precipitant events and providing supportive treatment for organ failures are currently the cornerstone of ACLF therapy. Although new clinical specific therapies have been researched, more studies are necessary to assess safety and efficacy. Therefore, future ACLF management strategies must consider measures to improve access to liver transplantation because the time window for this life-saving therapy is frequently narrow. Thus, an urgent and global discussion about allocation and prioritization for transplantation in critically ill ACLF patients is needed because there is evidence suggesting that the current model may not portray their waitlist mortality. In addition, while donor organ quality is meant to be a prognostic factor in the ACLF setting, recent evidence suggests that machine perfusion of the liver may be a safe tool to improve the donor organ pool and expedite liver transplantation in this scenario., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2022
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