Frontiers in Cardiovascular Medicine (Oct 2023)
Pushing the boundaries of innovation: the potential of ex vivo organ perfusion from an interdisciplinary point of view
- Jasper Iske,
- Jasper Iske,
- Andreas Schroeter,
- Andreas Schroeter,
- Samuel Knoedler,
- Samuel Knoedler,
- Timo Z. Nazari-Shafti,
- Timo Z. Nazari-Shafti,
- Leonard Wert,
- Leonard Wert,
- Maximilian J. Roesel,
- Maximilian J. Roesel,
- Maximilian J. Roesel,
- Felix Hennig,
- Felix Hennig,
- Adelheid Niehaus,
- Christian Kuehn,
- Christian Kuehn,
- Christian Kuehn,
- Fabio Ius,
- Fabio Ius,
- Volkmar Falk,
- Volkmar Falk,
- Volkmar Falk,
- Volkmar Falk,
- Moritz Schmelzle,
- Arjang Ruhparwar,
- Arjang Ruhparwar,
- Arjang Ruhparwar,
- Axel Haverich,
- Axel Haverich,
- Axel Haverich,
- Christoph Knosalla,
- Christoph Knosalla,
- Christoph Knosalla,
- Stefan G. Tullius,
- Florian W. R. Vondran,
- Bettina Wiegmann,
- Bettina Wiegmann,
- Bettina Wiegmann
Affiliations
- Jasper Iske
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Jasper Iske
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Andreas Schroeter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
- Andreas Schroeter
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Timo Z. Nazari-Shafti
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Timo Z. Nazari-Shafti
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Leonard Wert
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Leonard Wert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Maximilian J. Roesel
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Maximilian J. Roesel
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Maximilian J. Roesel
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Felix Hennig
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Felix Hennig
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Adelheid Niehaus
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Christian Kuehn
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Christian Kuehn
- German Center for Lung Research (DZL), Hannover, Germany
- Christian Kuehn
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- Fabio Ius
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Fabio Ius
- German Center for Lung Research (DZL), Hannover, Germany
- Volkmar Falk
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Volkmar Falk
- 0DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Volkmar Falk
- 1Department of Health Science and Technology, Translational Cardiovascular Technology, ETH Zurich, Zürich, Switzerland
- Moritz Schmelzle
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
- Arjang Ruhparwar
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Arjang Ruhparwar
- German Center for Lung Research (DZL), Hannover, Germany
- Arjang Ruhparwar
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- Axel Haverich
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Axel Haverich
- German Center for Lung Research (DZL), Hannover, Germany
- Axel Haverich
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- Christoph Knosalla
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Christoph Knosalla
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Christoph Knosalla
- 0DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Stefan G. Tullius
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Florian W. R. Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
- Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Bettina Wiegmann
- German Center for Lung Research (DZL), Hannover, Germany
- Bettina Wiegmann
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover, Germany
- DOI
- https://doi.org/10.3389/fcvm.2023.1272945
- Journal volume & issue
-
Vol. 10
Abstract
Ex vivo machine perfusion (EVMP) is an emerging technique for preserving explanted solid organs with primary application in allogeneic organ transplantation. EVMP has been established as an alternative to the standard of care static-cold preservation, allowing for prolonged preservation and real-time monitoring of organ quality while reducing/preventing ischemia–reperfusion injury. Moreover, it has paved the way to involve expanded criteria donors, e.g., after circulatory death, thus expanding the donor organ pool. Ongoing improvements in EVMP protocols, especially expanding the duration of preservation, paved the way for its broader application, in particular for reconditioning and modification of diseased organs and tumor and infection therapies and regenerative approaches. Moreover, implementing EVMP for in vivo-like preclinical studies improving disease modeling raises significant interest, while providing an ideal interface for bioengineering and genetic manipulation. These approaches can be applied not only in an allogeneic and xenogeneic transplant setting but also in an autologous setting, where patients can be on temporary organ support while the diseased organs are treated ex vivo, followed by reimplantation of the cured organ. This review provides a comprehensive overview of the differences and similarities in abdominal (kidney and liver) and thoracic (lung and heart) EVMP, focusing on the organ-specific components and preservation techniques, specifically on the composition of perfusion solutions and their supplements and perfusion temperatures and flow conditions. Novel treatment opportunities beyond organ transplantation and limitations of abdominal and thoracic EVMP are delineated to identify complementary interdisciplinary approaches for the application and development of this technique.
Keywords
- transplantation
- transplantation heart
- ex vivo organ perfusion
- machine perfusion
- ex vivo machine perfusion
- organ modification
