Transforming Transplant Oversight: Enhancing Combined Cardiothoracic Surgery and Liver Transplantation With Normothermic Machine Perfusion

Beatrice Cazzaniga, MD; Khaled Ali, MD; Jiro Kusakabe, MD, PhD, MPH; Qiang Liu, MD, PhD, MSc; Munkhbold Tuul, MD, PhD; Yuki Miyazaki, MD; Esteban Calderon, MD; Kumaran Shanmugarajah, MD, PhD; Glenn Wakam, MD; Chase J. Wehrle, MD; Mingyi Zhang, MD; Alejandro Pita, MD; Masato Fujiki, MD, PhD; Jaekeun Kim, MD; Andrea Schlegel, MD, MBA; Bijan Eghtesad, MD; Choon H. David Kwon, MD, PhD; Federico Aucejo, MD; Mazhar Khalil, MD; Teresa Diago-Uso, MD; Michael Z.-Y. Tong, MD; Shinya Unai, MD; Kenneth R. McCurry, MD; Maan Fares, MD; Jamak Modaresi-Esfeh, MD; Jacek Cywinski, MD; Cristiano Quintini, MD; Charles Miller, MD; Koji Hashimoto, MD, PhD

doi:10.1097/TXD.0000000000001810

Transplantation Direct (Jun 2025)

Transforming Transplant Oversight: Enhancing Combined Cardiothoracic Surgery and Liver Transplantation With Normothermic Machine Perfusion

Beatrice Cazzaniga, MD,
Khaled Ali, MD,
Jiro Kusakabe, MD, PhD, MPH,
Qiang Liu, MD, PhD, MSc,
Munkhbold Tuul, MD, PhD,
Yuki Miyazaki, MD,
Esteban Calderon, MD,
Kumaran Shanmugarajah, MD, PhD,
Glenn Wakam, MD,
Chase J. Wehrle, MD,
Mingyi Zhang, MD,
Alejandro Pita, MD,
Masato Fujiki, MD, PhD,
Jaekeun Kim, MD,
Andrea Schlegel, MD, MBA,
Bijan Eghtesad, MD,
Choon H. David Kwon, MD, PhD,
Federico Aucejo, MD,
Mazhar Khalil, MD,
Teresa Diago-Uso, MD,
Michael Z.-Y. Tong, MD,
Shinya Unai, MD,
Kenneth R. McCurry, MD,
Maan Fares, MD,
Jamak Modaresi-Esfeh, MD,
Jacek Cywinski, MD,
Cristiano Quintini, MD,
Charles Miller, MD,
Koji Hashimoto, MD, PhD

Affiliations

Beatrice Cazzaniga, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Khaled Ali, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Jiro Kusakabe, MD, PhD, MPH: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Qiang Liu, MD, PhD, MSc: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Munkhbold Tuul, MD, PhD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Yuki Miyazaki, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Esteban Calderon, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Kumaran Shanmugarajah, MD, PhD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Glenn Wakam, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Chase J. Wehrle, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Mingyi Zhang, MD: 2 Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH.
Alejandro Pita, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Masato Fujiki, MD, PhD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Jaekeun Kim, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Andrea Schlegel, MD, MBA: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Bijan Eghtesad, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Choon H. David Kwon, MD, PhD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Federico Aucejo, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Mazhar Khalil, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Teresa Diago-Uso, MD: 3 Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Emirates.
Michael Z.-Y. Tong, MD: 4 Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Shinya Unai, MD: 4 Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Kenneth R. McCurry, MD: 4 Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Maan Fares, MD: 5 Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Jamak Modaresi-Esfeh, MD: 6 Department of Gastroenterology, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Jacek Cywinski, MD: 7 Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH.
Cristiano Quintini, MD: 3 Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Emirates.
Charles Miller, MD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.
Koji Hashimoto, MD, PhD: 1 Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH.

DOI: https://doi.org/10.1097/TXD.0000000000001810
Journal volume & issue: Vol. 11, no. 6
p. e1810

Abstract

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Background. Simultaneous cardiothoracic surgery and liver transplantation (LT) is a high-risk procedure associated with high mortality and morbidity rates. The use of normothermic machine perfusion (NMP) allows graft quality enhancement, assessment of liver viability, and logistics optimization, expanding the donor pool and reducing organ discard rate. We share our institution’s experience with simultaneous cardiothoracic surgery and LT, using NMP for liver graft preservation and viability assessment. Methods. Data was retrospectively collected from 14 patients who underwent simultaneous cardiothoracic surgery and LT with NMP for liver graft preservation from October 2022 to August 2023. Data was divided into 3 groups: combined heart transplant and LT, lungs transplant and LT, and nontransplant cardiothoracic surgery and LT. Results. All liver grafts were from brain-dead donors. Median machine perfusion times were 211 min (range, 186–242 min), 222 min (range, 211–246 min), and 627 min (range, 180–1003 min) across the 3 groups, respectively. Postreperfusion syndrome occurred in 3 patients (21%), with 5 (36%) readmitted within 30 d because of complications. Biliary complications developed in 5 patients (36%), and 2 (14%) experienced acute liver rejection within 90 d postsurgery. No mortality was recorded during the median 18-mo follow-up. Conclusions. NMP serves as a safe and valuable tool for patients in need of simultaneous cardiothoracic surgery and LT, potentially broadening the scope of eligibility for these complex procedures.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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