Copyright
©The Author(s) 2016.
World J Gastroenterol. May 14, 2016; 22(18): 4438-4445
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4438
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4438
Table 1 Comparison of hypothermic and normothermic mechanical perfusion
Hypothermic mechanical perfusion | Normothermic mechanical perfusion | |
Temperature | 4 °C | 37 °C |
Pathophysiology | Reduced cellular metabolism | Continued cellular metabolism |
Non-functioning liver during preservation | Functioning liver during preservation | |
Perfusate | No specific requirements, oxygen can be used | Continuous delivery of nutrients and oxygen needs to be maintained |
Logistics | Similar to that of hypothermic mechanical perfusion currently used for renal allografts | More complex |
Benefits | Logistically easier | Allows for the assessment of metabolic and synthetic function during preservation |
May provide benefit in marginal livers | May provide benefit in marginal livers | |
Potential use in steatotic livers | ||
Felt to reduce ischemia reperfusion injury |
Table 2 Current data for donor-specific HLA-antibody-associated injuries in kidney and liver transplantation
Kidney transplantation | Liver transplantation | |
DSA specificity and levels | ↑ risk hyperacute rejection[44]; ↑ DSA in new onset late kidney allograft dysfunction[45]; acute AMR is associated with high posttransplant DSA levels[45] | ↑ DSA in recipients with CR, presence of IgG3 subclass associated with ↑ risk of graft loss[40] |
C4d deposition in microvasculature | Graft failure significantly worse in the presence of C4d+ staining[44]; C4d+ is a marker of antibody-mediated injury[44,46] | C4d+ staining nonspecific; In the presence of DSA, linear portal capillary and sinusoidal staining observed in ACR; DSA negative C4d+ staining found in biliary strictures and recurrent liver disease[47] |
DSA subtypes, C1q binding | ↓ graft survival and ↑ risk for AMR with C1q-binding DSA[48,49] | Limited data[50] |
Microvascular inflammation | Peritubular capillaritis is a possible predictor of chronic AMR[51]; subclinical AMR may contribute to development of CAN[52] | No current data |
EC activation by light microscopy | EC and BM ultrastructural abnormalities in glomerular and peritubular capillaries are early markers of TXG[53] | No current data |
Gene expression profile of chronic AMR | Defined genetic profile in AMR[54,55] | No current data |
Therapeutic-trials to prevent DSA-associated injury | Bortezomib (plasma cell-targeted therapy) as a possible antihumoral therapy[56]; plasma exchange for AMR[57,58] | No current data |
- Citation: Jadlowiec CC, Taner T. Liver transplantation: Current status and challenges. World J Gastroenterol 2016; 22(18): 4438-4445
- URL: https://www.wjgnet.com/1007-9327/full/v22/i18/4438.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i18.4438