OBM Transplantation

ISSN 2577-5820
Free Publication in 2018

Current Issue: 2018  Archive: 2017 
Editorial

The Fundamental Challenges in Organ Transplantation

Pål Dag Line 

  1. Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

Received: December 20, 2017 | Accepted: December 21, 2017 | Published: December 24, 2017

OBM Transplantation 2017, Volume 1, Issue 4, doi:10.21926/obm.transplant.1704006

Academic Editor: Nandini Nair

Recommended citation:  Line PD. The Fundamental Challenges in Organ Transplantation . OBM Transplantation 2017;1(4):006; doi:10.21926/obm.transplant.1704006.

© 2017 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Organ transplantation is a unique form of therapy for organ failure. The results are overall extremely good, saving the lives of a large cohort of patients that would otherwise die or be left with reduced life expectancy and a poor quality of life. Yet, the success of transplantation creates a problem that is increasingly difficult to manage, - the shortage of organ grafts available for transplantation. Simultaneously, the average age of deceased donors increases in most western countries, and a high prevalence of life-style associated diseases like obesity, diabetes and hypertension impacts organ quality. Various strategies have been applied to cope with the ever-increasing demand for organs. Extended criteria grafts can in many instances be used successfully if transplanted to properly selected recipients, but are associated with an increased risk of short and long-term graft loss due to poor function. Donation after circulatory death as an adjunct to donation after brain death have been successfully introduced in many countries and currently contributes to a significant part of all organs transplanted in Europe and the US [1]. Both strategies have raised the need for close monitoring of organ function and therapeutic measures to improve organ quality. Machine perfusion of organs could be a way to both reduce the negative impact of ischemia [2,3] but moreover as an innovative strategy for reducing the ischemia-reperfusion injury at revascularization [4]. Ultimately the concept of using ex-vivo perfusion as a way to achieve reconditioning of organs in order to convert “non-transplantable organs” into acceptable grafts has emerged. The approached was pioneered in Lungs by Steen and coworkers in Sweden in 2007 [5]. Recently, a similar approach have been reported in liver transplantation [6,7]. The significant progress seen in organ preservation and possible reconditioning over the recent years has even made heart transplantation after circulatory death possible [8]. The concerted efforts of the transplant community to find new innovative strategies to alleviate organ shortage is a result of continuous and systematic work, and clearly demonstrates the importance of scientific medicine in improving the treatment and care for our patients.

References

  1. Saidi RF, Hejazii Kenari SK. Challenges of organ shortage for transplantation: solutions and opportunities. Int J Organ Transplant Med. 2014;5:87-96.
  2. Moers C, Smits JM, Maathuis MH, Treckmann J, Van GF, Napieralski BP, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med. 2009;360:7-19. [CrossRef]
  3. De CR, Lauterio A, Ferla F, Di SS, Sguinzi R, De CL. Hypothermic machine perfusion of liver grafts can safely extend cold ischemia for up to 20 hours in cases of necessity. Transplantation. 2017;101:e223-e224. [CrossRef]
  4. Kron P, Schlegel A, Mancina L, Clavien PA, Dutkowski P. Hypothermic oxygenated perfusion (HOPE) for fatty liver grafts in rats and humans. J Hepatol. 2017;21:82-91.
  5. Steen S, Ingemansson R, Eriksson L, Pierre L, Algotsson L, Wierup P, et al. First human transplantation of a nonacceptable donor lung after reconditioning ex vivo. Ann Thorac Surg. 2007;83:2191-2194. [CrossRef]
  6. Mergental H, Perera MT, Laing RW, Muiesan P, Isaac JR, Smith A, et al. Transplantation of declined liver allografts following normothermic Ex-Situ evaluation. Am J Transplant. 2016;16:3235-3245. [CrossRef]
  7. Compagnon P, Levesque E, Hentati H, Disabato M, Calderaro J, Feray C, et al. An oxygenated and transportable machine perfusion system fully rescues liver grafts exposed to lethal ischemic damage in a pig model of DCD liver transplantation. Transplantation. 2017;101:e205-e213. [CrossRef]
  8. Messer S, Page A, Axell R, Berman M, HernándezSánchez J, Colah S, et al. Outcome after heart transplantation from donation after circulatory-determined death donors. J Heart Lung Transplant. 2017;36:1311-1318. [CrossRef]