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• W2808247249 abstract "To the editor: We would like to thank Otto van Leeuwen and colleagues for their interest in our paper titled “The First Case of Ischemia-Free Organ Transplantation (IFOT) in Human: A Proof of Concept.”1van Leeuwen OB, Ubbink R, de Meijer VE, Porte RJ. Letter to the editor: the first case of ischemia-free organ transplantation in humans: a proof of concept [published online ahead of print 2018]. Am J Transplant. https://doi.org/10.1111/ajt.14869Google Scholar,2He X Guo Z Zhao Q et al.The first case of ischemia-free organ transplantation in humans: a proof of concept.Am J Transplant. 2018; 18: 2092-2093Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar We appreciate that their team considers our innovation of IFOT “a milestone in the history of organ transplantation.” All conventional transplant procedures require cessation of blood supply to the donor organs, a period in which the organs become cold and hypoxic. The restoration of oxygen supply after ischemia exacerbates the initial cellular damage, which is known as ischemia and reperfusion injury (IRI). IRI is considered an unavoidable event that affects transplant outcomes considerably. Tremendous efforts have been made to minimize the damage from IRI. However, all of them are of limited success because none of these interventions is able to avoid the procedures leading to ischemia and subsequent IRI. We therefore developed a procedure that allows continuous normothermic and oxygenated blood supply to the organs during procurement, preservation, and implantation for liver transplantation. We have performed 16 ischemia-free liver transplantations (IFLT) for patients with end-stage liver disease. The clinical and laboratory results have shown that IRI is largely avoided for the first time in the history of organ transplantation. In addition, we have performed the first ischemia-free kidney transplantation on April 9, 2018, suggesting the concept of IFOT can be expanded to other organ transplantation. Van Leeuwen et al. pointed out that the perfusion machine that we are currently using is not suitable for transportation. Two examples of available transportable perfusion machines are OrganOx and OCS™ Liver.3Ravikumar R Jassem W Mergental H et al.Liver transplantation after ex vivo normothermic machine preservation: a phase 1 (first-in-man) clinical trial.Am J Transplant. 2016; 16: 1779-1787Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar Our research team will also continue to develop and modify our own multivisceral perfusion device,4He X Ji F Zhang Z et al.Combined liver-kidney perfusion enhances protective effects of normothermic perfusion on liver grafts from donation after cardiac death.Liver Transpl. 2018; 24: 67-79Crossref PubMed Scopus (11) Google Scholar making it more compact and transport friendly. The second limitation that van Leeuwen et al. pointed out was the technical complexity and they proposed a modification in obtaining access to the portal venous circulation by retrograde cannulation of a surgically reopened umbilical vein. We considered this modification early this year and conducted a preliminary experiment to test the feasibility of accessing the portal venous circulation via the umbilical vein in a porcine model (Figure 1). The perfusion parameters, biochemical analysis of perfusate and bile production, suggested the usage of umbilical vein is a feasible alternative. Additional modifications that are currently underway include new surgical techniques, improved cannula and tube design, and an updated perfusion device. We aim to simplify the technique so that IFOT can be adopted in the majority of transplant centers all over the world. We thank Leeuwen et al. for saying that “IFOT could become the preferred preservation method for extended criteria donor organs, especially those with an increased susceptibility for IRI.” The application of IFOT could not only expand the donor pool but also (maybe more important) optimize the transplant outcomes. Therefore, we believe IFOT would likely change the current clinical practice and the era of “Warm Organ Transplantation” is coming. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation." @default.
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• W2808247249 date "2018-08-01" @default.
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• W2808247249 title "The era of “Warm Organ Transplantation” is coming" @default.
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• W2808247249 doi "https://doi.org/10.1111/ajt.14935" @default.
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