Can hypothermic oxygenated perfusion (HOPE) rescue futile DCD liver grafts?

BACKGROUND: The new UK-DCD-Risk-Score has been recently developed to predict graft loss in DCD liver transplantation. Donor-recipient combinations with a cumulative risk of >10 points were classified as futile and achieved an impaired one-year graft survival of <40%. The aim of this study was to show, if hypothermic oxygenated perfusion (HOPE) can rescue such extended DCD livers and improve outcomes. METHODS: "Futile"-classified donor-recipient combinations were selected from our HOPE-treated human DCD liver cohort (01/2012-5/2017), with a minimum follow-up of one year. Main risk factors, which contribute to the classification "futile" include: elderly donors>60years, prolonged functional donor warm ischemia time (fDWIT > 30min), long cold ischemia time>6hrs, donor BMI>25 kg/m2, advanced recipient age (>60years), MELD-score>25points and retransplantation status. Endpoints included all outcome measures during and after DCD LT. RESULTS: Twenty-one donor-recipient combinations were classified futile (median UK-DCD-Risk-Score:11 points). The median donor age and fDWIT were 62 years and 36 min, respectively. After cold storage, livers underwent routine HOPE-treatment for 120 min. All grafts showed immediate function. One-year and 5-year tumor death censored graft survival was 86%. CONCLUSION: HOPE-treatment achieved excellent outcomes, despite high-risk donor and recipient combinations. Such easy, endischemic perfusion approach may open the door for an increased utilization of futile DCD livers in other countries.

[Modification of avian humoral immunoreactions by Influex and Echinacea angustifolia extract]. / Beeinflussung der aviären humoralen Immunreaktionen durch Influex und Echinacea Angustifolia Extrakt.

Medicinal complex drugs as well as single ethanolic or aqueous extracts of several plants are commonly used to increase the natural resistance to various infections, though their efficacy and mechanism of action are not yet well elucidated. In the present study, we investigated two problems: firstly, whether the complex drug (Influex) and Echinacea angustifolia extract do stimulate the immunoglobulin and antibody synthesis in chickens immunized with human serum albumin; and secondly, whether a restoration of IgG-synthesis in immunodefective (dysgammaglobulinemic) UM-B 19 chickens is possible with these plant preparations, i.e. if the BG cells which may possibly be present can be polyclonally or antigen specifically stimulated. The preparations were administered orally in two doses, after which the complete immunoglobulin concentration was determined by rocket immunoelectrophoresis and the antibody production by ELISA. The effect of ethanolic solvent was taken into account. The administration of the complex drug to normal Leghorn chickens induced a rise in the serum immunoglobulin concentration, as well as an increase in the three classes of antibody. By the immunodeficient chickens (IgG concentration was below the level of test sensitivity at the start), the administration of the drug led to a slight production in IgG and antibody.