title: Controlled Oxygenated Rewarming of Cold Stored Livers Prior to Transplantation: First Clinical Application of a New Concept.
abstract: BACKGROUND
  Abrupt temperature shift from hypothermia to normothermia incurred on reperfusion of organ grafts has been delineated as a genuine factor contributing to reperfusion injury and graft dysfunction after transplantation.
  
  
  METHODS
  In a first clinical series of 6 patients, cold-stored livers, all allocated by the rescue offer mechanism by Eurotransplant, were subjected to machine-assisted slow controlled oxygenated rewarming (COR) for 90 minutes before engrafting. A historical cohort of 106 patients basically similar in graft (all rescue offer organs) and recipient factors was used for comparison.
  
  
  RESULTS
  The clinical benefit of COR was documented by a significant reduction by approximately 50% in peak serum transaminases after transplantation compared to untreated controls (AST 563.5 vs. 1204 U/L, P = 0.023). After 6 months graft survival was 100% in the COR group and 80.9% in the controls (P = 0.24). Respective patient survival was 100% and 84.7% (P = 0.28). Real-time assessment of glucose concentration in the perfusion solution correlated well with postoperative synthetic graft function (r = 0.78; P < 0.02). All treated recipients had normal liver function after a 6-month follow-up and are well and alive.
  
  
  CONCLUSIONS
  This first clinical application suggests that controlled graft rewarming after cold storage is a feasible and safe method in clinical praxis and might become an adjunct in organ preservation.
authors.affiliation: 1 General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. 2 Clinic for Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany. 3 Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. 4 Surgical Research Division, University Hospital Bonn, Bonn, Germany.
authors.forename: Dieter P
authors.initials: DP
authors.lastname: Hoyer
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mathé
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
authors.forename: Ali C
authors.initials: AC
authors.lastname: Canbay
authors.forename: Juergen W
authors.initials: JW
authors.lastname: Treckmann
authors.forename: Ursula
authors.initials: U
authors.lastname: Rauen
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Thomas
authors.initials: T
authors.lastname: Minor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D050377:Cold Ischemia / Q000009:adverse effects / Q000401:mortality; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000009:adverse effects / Q000627:therapeutic use*; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D017694:Rewarming / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010100:Oxygen