Surgery in Practice and Science (Sep 2022)
Hemoglobin-based oxygen carriers: Clinical application of HBOC-201 as an alternative to red blood cells for machine perfusion in liver transplantation
Abstract
Background: Liver transplantation is the gold standard treatment option for end-stage liver diseases and failure. In recent years, ex vivo liver machine perfusion has been introduced to resuscitate livers before transplantation. The RBC-based solution is the main perfusate for this matter. Due to logistic and functional limitations in order to use an RBC-based solution, Hemoglobin-based oxygen carrier-201 (HBOC-201) is the new perfusion solution that is introduced to replace the RBC-based solution. Methods: A systematic literature search of the PubMed registry was performed. A three-stage independent screening method was applied. Inclusion criteria for this review were published prospective, retrospective, clinical trials, and systematic reviews studies using acellular hemoglobin as a perfusion solution. Results: Five studies that used HBOC-201 as the perfusate solution were identified. The overall number of livers that were resuscitated with HBOC-201 perfusate in all the studies was 50 livers. These studies have demonstrated the efficacy of HBOC-201 perfusate in terms of liver post perfusion metabolic and function assessment. Two studies compared HBOC-201 and PRBC as the perfusate solution. One study found comparable outcomes when HBOC-201 was used as the perfusate solution and in the other study, not only the results were comparable, but also, the study showed livers perfusate with HBOC-201 based solution had higher ATP levels, higher bile production, and quicker lactate reduction, and significantly lower ALT level at the end of MP. Conclusion: Machine perfusion (MP) was introduced as an alternative preservation strategy in transplantation. The perfusion solution used in MP is a key factor in the process of organ revitalization, preventing hemolysis, and providing near-to-body physiologic hemostasis. HBOC-201 is a safe and convenient alternative to packed red blood cells in organ perfusion and recent studies showed promising results.
